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1.
Orv Hetil ; 161(1): 3-10, 2020 Jan.
Artigo em Húngaro | MEDLINE | ID: mdl-31884813

RESUMO

The rapidly evolving field of repetitive transcranial magnetic stimulation as a neuromodulational technique may mean a safe, alternative approach to the management of several mental disorders, especially treatment-resistant major depressive disorder. Our aim is to describe the current role of transcranial magnetic stimulation in research and routine clinical practice, based on the literature and clinical protocols. Since the discovery, that an outer magnetic source can depolarize neurons, both neurology and psychiatry seek the method's possible clinical utility. To date, in the field of psychiatry, the method is only approved in the treatment of major depressive disorder and obsessive-compulsive disorder, but research continues to find application in other mental disorders (schizophrenia, bipolar disorder), too. The next step in the evolution of repetitive transcranial magnetic stimulation is based on magnetic resonance guided, real-time navigation with the help of positioning algorithms. The so-called neuronavigational systems make precise aiming of neuronal circuits responsible for the development of depression, thus increasing the excitability of the left dorsolateral prefrontal cortex and decreasing it on the right hemisphere. The method has few contraindications, and the occurrence of side effects can be minimized by carefully selected patient population. For today, transcranial magnetic stimulation became an evidence-based, effective treatment for some mental disorders, especially treatment-resistant major depressive disorder. It is to be assumed that in the future neuronavigational neuromodulation techniques, including repetitive transcranial magnetic stimulation, will be widely used in the field of psychiatry and neurology. Magnetic stimulation is currently available in a number of centres in Hungary, but the financial approval and the implementation of this neuromodulation method for treating mental disorders in the everyday clinical practice are still in progress. Orv Hetil. 2020; 161(1): 3-10.


Assuntos
Transtorno Depressivo Maior/terapia , Estimulação Magnética Transcraniana/métodos , Transtorno Depressivo Maior/psicologia , Humanos , Hungria , Córtex Pré-Frontal , Estimulação Magnética Transcraniana/efeitos adversos , Resultado do Tratamento
2.
Psychiatr Hung ; 35(1): 58-67, 2020.
Artigo em Húngaro | MEDLINE | ID: mdl-31854323

RESUMO

INTRODUCTION: Several long-term follow-up studies investigate the progression of adolescent onset major depressive disorder but much less explore short and long-term consequences and prognosis into adulthood of childhood- onset depression. The aim of the present study is to follow childhood-onset depression, lifetime comorbid psychiatric disorders and suicidal behavior into adulthood. METHODS: Subjects (N=166) were 25.95+2.42 years old on average, 54.2% were women. Follow-up period lasted for a mean of 14.74+1.31 years. Psychiatric diagnosis was assessed by a DSM-IV based semi-structured interview. Subjects reported on 4 stages of suicidal behavior as one of the symptoms of depressive disorder. RESULTS: The onset of the first depressive episode was at the mean age of 10.17+2.34 years. 40,4% of the sample had only 1 episode while recurrent depressive episode presented in 32.5% above 18 years of age. Lifetime comorbid psychiatric disorders were present in more than 1/3 of the sample. The most frequent lifetime comorbidity was anxiety (42.4%), and specific phobia among anxiety disorders. Lifetime attention deficit-hyperactivity disorder and oppositional/conduct disorder were also frequent (25.9% and 16.9%, respectively). Suicidal behavior was not present life-time in 19.1% of the sample. Thoughts of death and thoughts of suicide were quite frequent (80.8% and 69.5%, respectively), specific plans and suicidal attempt were more frequent in girls (plan:female vs male 53.9% vs 38.4%, attempt: 33.3% vs 9.6%) during follow-up. CONCLUSION: About one-third of childhood-onset depression had recurrence above 18 years of age, which is lower than the recurrence rate for adolescent onset depression. A high rate of lifetime comorbidity was found between depression and anxiety disorders. The assessment of the actual level of suicidal behavior is important in the prevention of selfdestructive behavior.


Assuntos
Depressão/diagnóstico , Depressão/psicologia , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/psicologia , Suicídio/psicologia , Adolescente , Adulto , Idade de Início , Transtornos de Ansiedade/complicações , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/psicologia , Criança , Comorbidade , Depressão/complicações , Transtorno Depressivo Maior/complicações , Feminino , Seguimentos , Humanos , Masculino , Prognóstico , Fatores de Risco , Adulto Jovem
3.
Medicine (Baltimore) ; 98(52): e18515, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31876742

RESUMO

Although functional impairment is very common among patients with major depressive disorder (MDD) and is a necessary diagnostic criterion for MDD, clinicians have not directed their attention beyond the mood symptoms of MDD. We aimed to multi-dimensionally assess the functional abilities of patients with MDD using a standardized scale of adaptive function reported by caregivers or parents to identify the nature and degree of functional impairment in patients with MDD.This study was conducted in 40 depressive patients aged 19 to 60 years. Patients were screened according to the DSM-IV-TR and a Hamilton Depression Rating Scale score ≥8. We administered the parent/caregiver rating form of the Korean Vineland Adaptive Behavior Scale to assess functional outcomes in the patients.Patients with MDD showed significant differences in both global and domain-specific functional abilities compared to those of the normal group (all t > -6.35, P < .05) and the patients' premorbid IQ (all t > 4.30, P < .001). The number of episodes among clinical factors was negatively correlated with overall adaptive functioning (r = -0.32, P < .05) and expressive communication (r = -0.42, P < .01).Our present study replicates existing evidence showing impairment in both broad and various functional areas in patients with MDD, suggesting the importance of quantitatively assessing functional outcomes and acquiring information about functioning from informants other than patients.


Assuntos
Atividades Cotidianas/psicologia , Transtorno Depressivo Maior/psicologia , Adaptação Psicológica , Adulto , Feminino , Humanos , Entrevista Psicológica , Masculino , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Adulto Jovem
4.
Psychiatr Hung ; 34(4): 359-368, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31767796

RESUMO

The risk of suicidal behaviour in mood disorders is an inherent severity of the depressive episode. Suicidal behaviour in patients with mood disorders is both state and severity dependent, which means that suicidality markedly decreases or vanishes after clinical recovery. However, since the majority of mood disorder patients never commit or attempt suicide, special clinical characteristics of the illness, as well as some personality, familial and psycho-social factors should also play a contributory role. This paper discusses the clinically explorable suicide risk factors in patients with major mood disorders, with particular regard to the underlying bipolarity. Successful acute and longterm pharmacotherapy - supplemented by psycho-social interventions - markedly reduces the risk of attempted and completed suicide, even in this high-risk population. Keywords: major depressive disorder; bipolar disorders.


Assuntos
Transtorno Bipolar/psicologia , Depressão/psicologia , Transtorno Depressivo Maior/psicologia , Suicídio/psicologia , Transtorno Bipolar/terapia , Depressão/terapia , Transtorno Depressivo Maior/terapia , Humanos , Fatores de Risco , Ideação Suicida , Tentativa de Suicídio/psicologia
5.
Psychiatr Hung ; 34(4): 369-379, 2019.
Artigo em Húngaro | MEDLINE | ID: mdl-31767797

RESUMO

In this literature review the new trends of cognitive behavioural therapy (CBT), namely behavioural activation and rumination-focused cognitive behavioural therapy are introduced as new methods for the treatment of major depression. Component-analytical studies of CBT showed that besides cognitive restructuring, behavioural components play an important role as active treatment factors. Behavioural activation and rumination-focused CBT emphasize these processes. The central idea of behavioural activation is that negative experiences in depression result in secondary avoidant behaviour. Clients participating in such therapy learn to recognize and change avoidant behaviour. Rumination-focused CBT target repetitive negative thoughts that are considered a transdiagnostic maladaptive phenomenon. These conceptual and methodological can contribute substantially to the effectiveness of CBT for major depression.


Assuntos
Terapia Cognitivo-Comportamental , Depressão/psicologia , Depressão/terapia , Transtorno Depressivo Maior/psicologia , Transtorno Depressivo Maior/terapia , Aprendizagem da Esquiva , Humanos , Ruminação Cognitiva , Resultado do Tratamento
7.
Medicine (Baltimore) ; 98(42): e17518, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626112

RESUMO

Little is known about the relationship between levels of self-esteem and the development of depression in young adults. The present study investigated the relationship between self-esteem and depression to determine whether self-esteem levels are a risk factor for the development of depression in young adults. This study was conducted with 113 college students aged 19 to 35 (major depressive disorder (MDD) n = 44, Mild Depressive Symptoms (MDS) n = 37, Healthy Control n = 32). The levels of clinical symptoms, self-esteem, resilience, social support, and quality of life, as well as personality traits, were assessed (by Patient Health Questionnaire-9, generalized anxiety disease-7, State-Trait Anxiety Inventory-S, Resilience Appraisal Scale, Rosenberg Self-Esteem Scale, Quality of Life, and NEO-personality inventory (NEO-PI)). The MDS group with high self-esteem reported having the lowest levels of social support, resilience, agreeableness, and extraversion compared to those of the MDD group and control group with high self-esteem. In contrast, the MDS group with low self-esteem showed no differences in social support, resilience, agreeableness and openness according to the NEO-PI scale. Sex and age had no significant impact on the results. Levels of self-esteem are strongly associated with the development of depression. Results suggest that early intervention for depression in young adults needs to focus on improving their levels of social support, resilience, and positive domains of personality. Further studies on the effects of high self-esteem in the development of depression are warranted.


Assuntos
Depressão/psicologia , Transtorno Depressivo Maior/psicologia , Autoimagem , Estudantes/psicologia , Adulto , Feminino , Humanos , Masculino , Personalidade , Inventário de Personalidade , Qualidade de Vida , Resiliência Psicológica , Fatores de Risco , Apoio Social , Adulto Jovem
8.
Psychiatr Danub ; 31(Suppl 3): 237-241, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31488733

RESUMO

BACKGROUND: In a two-year study, we compared the efficacy of noradrenergic and serotonergic antidepressants with and without the addition of 100 mg acetylsalicylic acid (ASA) in subjects suffering from major depressive disorder (MDD). In this article we examine the influence of the health locus of control, family relationships and personality traits on the progress of MDD. SUBJECTS AND METHODS: 40 people with MDD (MDD group) were randomly assigned to the different treatment groups. They were followed in parallel with a group of 20 'healthy' subjects (HG). At the beginning of the study, sociodemographic data were collected, and patients were asked to complete the Multidimensional Health Locus of Control (MHLC) scale, the NEO Five-Factor Inventory (NEO-FFI), and the Family Adaptation and Cohesion Scale (FACES III). During the study subjects were regularly assessed using the Hamilton Depression Scale (HDS), the Short Form Health Survey (SF-12) and the Clinical Global Impression scale (CGI). RESULTS: Regardless of the type of treatment, physical health is the best predictor of variation at two years in the MDD group; 45% of variance is explained by a linear regression model that includes three variables from the MHLC, FACES III and NEO-FFI scales. Similarly, 40% of CGI and 24% of HDS variance is predicted. These explanatory variables are statistically less powerful in the MDD group than the HG group. CONCLUSION: While drug treatment is a determinant in changes on the HDS, CGI and SF12 scales, factors such as family relationships, MHLC or personality are important covariates of these changes. The question remains whether we can influence these covariates to improve the response to antidepressants.


Assuntos
Antidepressivos/uso terapêutico , Transtorno Depressivo Maior/tratamento farmacológico , Transtorno Depressivo Maior/psicologia , Relações Familiares , Controle Interno-Externo , Humanos , Escalas de Graduação Psiquiátrica
9.
Psychiatr Danub ; 31(Suppl 3): 258-260, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31488737

RESUMO

Suicidal ideations or attempts in patients with major depressive disorder (MDD) are emergent conditions that require immediate treatment. Numerous therapeutic interventions to reduce suicide risk in psychiatric disorders are effective in long-term suicide prevention, but there is necessity of sufficient, rapid pharmacological treatment of suicidal risk in MDD. Ketamine, an N-methyl-D-aspartate (NMDA) antagonist, has been reported to have rapid antidepressant effect. Depressive symptoms, anxiety, hopelessness, suicidal ideation had decreased within hours after ketamine infusion. Ketamine's rapid symptoms relief and reduction of suicide thoughts has aroused growing interests in psychiatric association.


Assuntos
Transtorno Depressivo Maior/tratamento farmacológico , Transtorno Depressivo Resistente a Tratamento/tratamento farmacológico , Ketamina/uso terapêutico , Suicídio/prevenção & controle , Depressão/tratamento farmacológico , Depressão/psicologia , Transtorno Depressivo Maior/psicologia , Transtorno Depressivo Resistente a Tratamento/psicologia , Humanos , Ideação Suicida , Suicídio/psicologia
10.
J Clin Neurosci ; 69: 21-25, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31473092

RESUMO

This study evaluated suicidality and its risk factors in patients with tension-type headache (TTH). We recruited new patients with TTH who visited general hospitals. We recorded their clinical characteristics and conducted the Headache Impact Test-6 (HIT-6) and the Insomnia Severity Index (ISI) for assessment. We also interviewed the patients to identify major depressive disorder (MDD), generalized anxiety disorder (GAD), and suicidality with the Mini International Neuropsychiatric Interview-Plus Version 5.0.0 (MINI). The frequency of suicidality was compared between TTH patients and healthy controls. Major risk factors for suicidality were also determined. A total of 332 TTH patients with the same number of healthy controls were recruited from five general hospitals. Suicidality was observed in 82 (24.7%) TTH patients. The frequency of suicidality was significantly higher in patients with TTH than in the controls. Furthermore, the frequency of suicidality was higher in patients with chronic TTH (CTTH) than in the controls. The major risk factors for suicidality were MDD, GAD, a low education level, insomnia, chronicity of TTH, and pericranial tenderness. Suicidal ideation or attempt seems to be a common feature in TTH. Therefore, it is important to identify risk factors related to suicidality in TTH patients, which may help reduce suicidality.


Assuntos
Ideação Suicida , Cefaleia do Tipo Tensional/psicologia , Adulto , Transtornos de Ansiedade/complicações , Transtornos de Ansiedade/psicologia , Estudos de Casos e Controles , Transtorno Depressivo Maior/complicações , Transtorno Depressivo Maior/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Fatores de Risco
11.
Psychiatr Hung ; 34(2): 185-198, 2019.
Artigo em Húngaro | MEDLINE | ID: mdl-31417007

RESUMO

Sylvia Plath was one of the most famous American poets in the twentieth century. Plath was diagnosed with depression after her first suicide attempt when she was 20 years old. Her major depression (without psychotic symptoms) recurred several times. Plath never had a manic episode, but there were probable hypomanic periods in her life. She died by violent suicide when she was 30. Sylvia Plath took a bottle of sleeping pills and stuck her head in a gas oven. Several factors may have contributed to Plath's psychiatric disorder and suicide. The author reviews the etiological factors and course of psychiatric disorder based on the Unabridged Journals of Sylvia Plath and the literature. Her family history was positive and her premorbid personality was vulnerable to depression. There were histrionic, narcissistic and borderline features in her personality. The probable diagnoses of Plath were bipolar II. affective disorder and mixed personality disorder.


Assuntos
Transtorno Bipolar/história , Transtorno Depressivo Maior/história , Transtorno Depressivo Maior/psicologia , Pessoas Famosas , Transtornos do Humor/história , Transtornos da Personalidade/história , Feminino , História do Século XX , Humanos , Literatura Moderna/história , Personalidade , Suicídio/história
12.
JAMA ; 322(7): 622-631, 2019 08 20.
Artigo em Inglês | MEDLINE | ID: mdl-31429896

RESUMO

Importance: Psychotic depression is a severely disabling and potentially lethal disorder. Little is known about the efficacy and tolerability of continuing antipsychotic medication for patients with psychotic depression in remission. Objective: To determine the clinical effects of continuing antipsychotic medication once an episode of psychotic depression has responded to combination treatment with an antidepressant and antipsychotic agent. Design, Setting, and Participants: Thirty-six week randomized clinical trial conducted at 4 academic medical centers. Patients aged 18 years or older had an episode of psychotic depression acutely treated with sertraline plus olanzapine for up to 12 weeks and met criteria for remission of psychosis and remission or near-remission of depressive symptoms for 8 weeks before entering the clinical trial. The study was conducted from November 2011 to June 2017, and the final date of follow-up was June 13, 2017. Interventions: Participants were randomized either to continue olanzapine (n = 64) or switch from olanzapine to placebo (n = 62). All participants continued sertraline. Main Outcomes and Measures: The primary outcome was risk of relapse. Main secondary outcomes were change in weight, waist circumference, lipids, serum glucose, and hemoglobin A1c (HbA1c). Results: Among 126 participants who were randomized (mean [SD] age, 55.3 years [14.9 years]; 78 women [61.9%]), 114 (90.5%) completed the trial. At the time of randomization, the median dosage of sertraline was 150 mg/d (interquartile range [IQR], 150-200 mg/d) and the median dosage of olanzapine was 15 mg/d (IQR, 10-20 mg/d). Thirteen participants (20.3%) randomized to olanzapine and 34 (54.8%) to placebo experienced a relapse (hazard ratio, 0.25; 95% CI, 0.13 to 0.48; P < .001). The effect of olanzapine on the daily rate of anthropometric and metabolic measures significantly differed from placebo for weight (0.13 lb; 95% CI, 0.11 to 0.15), waist circumference (0.009 inches; 95% CI, 0.004 to 0.014), and total cholesterol (0.29 mg/dL; 95% CI, 0.13 to 0.45) but was not significantly different for low-density lipoprotein cholesterol (0.04 mg/dL; 95% CI, -0.01 to 0.10), high-density lipoprotein cholesterol (-0.01 mg/dL; 95% CI, -0.03 to 0.01), triglyceride (-0.153 mg/dL; 95% CI, -0.306 to 0.004), glucose (-0.02 mg/dL; 95% CI, -0.12 to 0.08), or HbA1c levels (-0.0002 mg/dL; 95% CI, -0.0021 to 0.0016). Conclusions and Relevance: Among patients with psychotic depression in remission, continuing sertraline plus olanzapine compared with sertraline plus placebo reduced the risk of relapse over 36 weeks. This benefit needs to be balanced against potential adverse effects of olanzapine, including weight gain. Trial Registration: ClinicalTrials.gov Identifier: NCT01427608.


Assuntos
Transtornos Psicóticos Afetivos/tratamento farmacológico , Antipsicóticos/uso terapêutico , Transtorno Depressivo Maior/tratamento farmacológico , Olanzapina/uso terapêutico , Adolescente , Adulto , Idoso , Antidepressivos/uso terapêutico , Antipsicóticos/efeitos adversos , Transtorno Depressivo Maior/psicologia , Método Duplo-Cego , Quimioterapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Olanzapina/efeitos adversos , Modelos de Riscos Proporcionais , Prevenção Secundária , Sertralina/uso terapêutico , Adulto Jovem
13.
Sensors (Basel) ; 19(17)2019 Aug 25.
Artigo em Inglês | MEDLINE | ID: mdl-31450687

RESUMO

We present the first study in the literature that has aimed to determine Depression Anxiety Stress Scale (DASS) levels by analyzing facial expressions using Facial Action Coding System (FACS) by means of a unique noninvasive architecture on three layers designed to offer high accuracy and fast convergence: in the first layer, Active Appearance Models (AAM) and a set of multiclass Support Vector Machines (SVM) are used for Action Unit (AU) classification; in the second layer, a matrix is built containing the AUs' intensity levels; and in the third layer, an optimal feedforward neural network (FFNN) analyzes the matrix from the second layer in a pattern recognition task, predicting the DASS levels. We obtained 87.2% accuracy for depression, 77.9% for anxiety, and 90.2% for stress. The average prediction time was 64 s, and the architecture could be used in real time, allowing health practitioners to evaluate the evolution of DASS levels over time. The architecture could discriminate with 93% accuracy between healthy subjects and those affected by Major Depressive Disorder (MDD) or Post-traumatic Stress Disorder (PTSD), and 85% for Generalized Anxiety Disorder (GAD). For the first time in the literature, we determined a set of correlations between DASS, induced emotions, and FACS, which led to an increase in accuracy of 5%. When tested on AVEC 2014 and ANUStressDB, the method offered 5% higher accuracy, sensitivity, and specificity compared to other state-of-the-art methods.


Assuntos
Transtorno Depressivo Maior/psicologia , Face/fisiologia , Expressão Facial , Transtornos de Estresse Pós-Traumáticos/psicologia , Transtornos de Ansiedade/psicologia , Depressão/psicologia , Humanos , Prognóstico
15.
Int J Neural Syst ; 29(7): 1950005, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31387489

RESUMO

Although electroconvulsive therapy (ECT) is one of the most effective treatments for major depressive disorder (MDD), the mechanism underlying the therapeutic efficacy and side effects of ECT remains poorly understood. Here, we investigated alterations in the cortical morphological measurements including cortical thickness (CT), surface area (SA), and local gyrification index (LGI) in 23 MDD patients before and after ECT. Furthermore, multivariate pattern analysis using linear support vector machine (SVM) was applied to investigate whether the changed morphological measurements can be effective indicators for therapeutic efficacy of ECT. Surface-based morphometry (SBM) analysis found significantly increased vertex-wise and regional cortical thickness (CT) and surface area (SA) in widespread regions, mainly located in the left insula (INS) and left fusiform gyrus, as well as hypergyrification in the left middle temporal gyrus (MTG) in MDD patients after ECT. Partial correlational analyses identified associations between the morphological properties and depressive symptom scores and impaired memory scores. Moreover, SVM result showed that the changed morphological measurements were effective to classify the MDD patients before and after ECT. Our findings suggested that ECT may enhance cortical neuroplasticity to facilitate neurogenesis to remit depressive symptoms and to impair delayed memory. These findings indicated that the cortical morphometry is a good index for therapeutic efficacy of ECT.


Assuntos
Córtex Cerebral/diagnóstico por imagem , Transtorno Depressivo Maior/diagnóstico por imagem , Transtorno Depressivo Maior/terapia , Eletroconvulsoterapia/métodos , Máquina de Vetores de Suporte , Adulto , Transtorno Depressivo Maior/psicologia , Eletroconvulsoterapia/tendências , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Máquina de Vetores de Suporte/tendências
16.
Psicothema (Oviedo) ; 31(3): 335-340, ago. 2019. tab
Artigo em Inglês | IBECS | ID: ibc-185362

RESUMO

Background: The Brief Experiential Avoidance Questionnaire (BEAQ) has been suggested as the most appropriate instrument for measuring experiential avoidance. However, no Spanish validation has been published. The aim of this study was to validate a Spanish version of the BEAQ in a clinical sample treated at a community mental health unit. Methods: Participants (N = 332) completed the BEAQ as well as other self-report measures of experiential avoidance and psychopathology. Results: Internal consistency was satisfactory (α = .82). No statistically significant gender differences were found in the BEAQ scores. The data also showed high test-retest reliability after four to six weeks, acceptable concurrent validity with another experiential avoidance measure and acceptable convergent validity with the psychopathology measure. The principal component analysis, forcing the one factor solution proposed in the original scale, produced indicators similar to the English version of the BEAQ. Conclusions: These results firmly support the reliability and validity of this Spanish validation, stressing its usefulness as a measure of experiential avoidance in clinical populations


Antecedentes: el Cuestionario Breve de Evitación Experiencial (BEAQ) ha sido propuesto como el instrumento más adecuado para medir la evitación experiencial. Sin embargo, todavía no ha sido publicada ninguna validación en español. Por lo tanto, el objetivo del presente estudio ha sido la validación de una versión española del BEAQ, en una muestra clínica atendida en un Centro de Salud Mental Comunitario. Método: los participantes (N = 332) completaron el BEAQ, así como otras medidas de autoinforme de evitación experiencial y psicopatología. Resultados: la consistencia interna fue satisfactoria (α = .82). No se encontraron diferencias de género estadísticamente significativas en las puntuaciones del BEAQ. Los datos también mostraron una alta fiabilidad test-retest en un intervalo de cuatro a seis semanas, validez concurrente aceptable con otra medida de evitación experiencial y validez convergente aceptable con la medida de psicopatología. El análisis de componentes principales forzando a la solución de un factor, como se propuso en la escala original, obtuvo unos indicadores similares a los obtenidos en dicha versión inglesa. Conclusiones: los resultados confirman la adecuada fiabilidad y validez de la presente versión española del BEAQ, destacando su utilidad como medida de la evitación experiencial en población clínica


Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Questionário de Saúde do Paciente , Transtornos Mentais/diagnóstico , Transtornos Mentais/psicologia , Autorrelato , Transtornos de Adaptação/diagnóstico , Transtornos de Adaptação/psicologia , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/psicologia , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/psicologia , Transtorno Distímico/diagnóstico , Transtorno Distímico/psicologia , Transtornos da Alimentação e da Ingestão de Alimentos/diagnóstico , Transtornos da Alimentação e da Ingestão de Alimentos/psicologia , Transtorno Obsessivo-Compulsivo/diagnóstico , Transtorno Obsessivo-Compulsivo/psicologia , Transtornos da Personalidade/diagnóstico , Transtornos da Personalidade/psicologia , Psicometria , Reprodutibilidade dos Testes , Fatores Sexuais , Espanha
18.
Diabetes Metab Syndr ; 13(2): 1475-1479, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31336509

RESUMO

Efficacious adherence to treatment protocol predicts metabolic control among Type 2 diabetics (T2DM) [1-4]; however, few healthcare systems employ individualized strategies to mediate the comorbidity of T2DM with other chronic disease states. A clinically prescribed ketogenic diet, patient-centered nutritional education and high intensity interval training (HIIT), girded by solution-focused psychotherapy, modulate significant improvements in the clinical biomarkers associated with concurring T2DM and clinical depression [5-15]. Relevant metabolic change was noted in the following measures: HOMA-IR, triglyceride/HDL ratio, HgA1c, fasting insulin, fasting glucose, fasting triglycerides, LDL, VLDL, HDL, total cholesterol and C-reactive protein. The Patient Health Questionnaire 9 (PHQ-9) along with clinical interview and the mental status exam showed notable change in the patient's depressive symptoms; likewise, her self-efficacy score normalized, as measured by the General Self-Efficacy Questionnaire (GSE) and the Metabolic Syndrome Compliance Questionnaire (MSC). The case study highlights a 65-year old female who presented with a 26-year history of dually-diagnosed Type 2 diabetes (T2DM) and major depressive disorder (MDD). The patient was prescribed a ketogenic diet (KD), clinically formulated from her resting metabolic rate, body fat percentage and lean body mass, together with weekly nutrition education, high intensity interval training (matched to her cardiovascular conditioning), and eight 45-minute solution-focused psychotherapy sessions. Intervention goals included improved insulin sensitivity evaluated by the HOMA-IR, sustained glycemic control measured via HgA1c, reduced cardiovascular risk via the triglyceride/HDL ratio, and improved depressive symptoms with increased self-efficacy monitored by the PHQ-9 and GSE/MSC. The results of the 12-week intervention were statistically significant. The patient's HgA1c dropped out of diabetic range (8.0%) and normalized at 5.4%. Her average daily glucose measurements declined from 216 mg/dL to 96 mg/dL; the HOMA-IR and triglyceride/HDL ratios improved by 75%. Her marker for clinical depression and measurement of self-efficacy normalized. The 12-week individualized treatment intervention served to functionally reverse 26 years of T2DM, ameliorate two and half decades of chronic depressive disorder and empower/equip the patient with a new experience of hope and success.


Assuntos
Transtorno Depressivo Maior/prevenção & controle , Diabetes Mellitus Tipo 2/dietoterapia , Dieta Cetogênica , Idoso , Transtorno Depressivo Maior/etiologia , Transtorno Depressivo Maior/psicologia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/psicologia , Feminino , Humanos , Prognóstico
19.
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
20.
Psicothema ; 31(3): 335-340, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31292050

RESUMO

BACKGROUND: The Brief Experiential Avoidance Questionnaire (BEAQ) has been suggested as the most appropriate instrument for measuring experiential avoidance. However, no Spanish validation has been published. The aim of this study was to validate a Spanish version of the BEAQ in a clinical sample treated at a community mental health unit. METHODS: Participants ( N = 332) completed the BEAQ as well as other self-report measures of experiential avoidance and psychopathology. RESULTS: Internal consistency was satisfactory (α = .82). No statistically significant gender differences were found in the BEAQ scores. The data also showed high test-retest reliability after four to six weeks, acceptable concurrent validity with another experiential avoidance measure and acceptable convergent validity with the psychopathology measure. The principal component analysis, forcing the one factor solution proposed in the original scale, produced indicators similar to the English version of the BEAQ. CONCLUSIONS: These results firmly support the reliability and validity of this Spanish validation, stressing its usefulness as a measure of experiential avoidance in clinical populations.


Assuntos
Autorrelato , Transtornos de Adaptação/diagnóstico , Transtornos de Adaptação/psicologia , Adolescente , Adulto , Idoso , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/psicologia , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/psicologia , Transtorno Distímico/diagnóstico , Transtorno Distímico/psicologia , Transtornos da Alimentação e da Ingestão de Alimentos/diagnóstico , Transtornos da Alimentação e da Ingestão de Alimentos/psicologia , Feminino , Humanos , Linguagem , Masculino , Transtornos Mentais/diagnóstico , Transtornos Mentais/psicologia , Pessoa de Meia-Idade , Transtorno Obsessivo-Compulsivo/diagnóstico , Transtorno Obsessivo-Compulsivo/psicologia , Questionário de Saúde do Paciente , Transtornos da Personalidade/diagnóstico , Transtornos da Personalidade/psicologia , Psicometria , Reprodutibilidade dos Testes , Transtornos das Sensações/psicologia , Fatores Sexuais , Adulto Jovem
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