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1.
Wiad Lek ; 75(9 pt 1): 2146-2151, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36256944

RESUMO

OBJECTIVE: The aim: To analyze the current research literature devoted to the study of the mechanisms of the realization of stress factors during pregnancy. PATIENTS AND METHODS: Materials and methods: The article presents an analysis and summarizes the literature devoted to the study of the mechanisms of the realization of stress factors during the pregnancy, the pathogenetic aspects of violations of the feto-placental complex, "critical periods of vulnerability", the long-term consequences of the transferred prenatal stress. CONCLUSION: Conclusions: The paper summarizes that the condition of the mother and the feto-placental complex play an important role in many aspects of fetal development, that determine baby's physical and emotional health, personality formation in the future.


Assuntos
Doenças Fetais , Síndrome de Adaptação Geral , Feminino , Humanos , Gravidez , Mães , Placenta
3.
Enferm. glob ; 19(60): 196-207, oct. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-200738

RESUMO

INTRODUCCIÓN: El cáncer es una de las principales causas de morbilidad y mortalidad en el mundo, según la Organización Mundial de la Salud (OMS), en 2012 14 millones de casos nuevos y 8,2 millones de muertes. Se demostró que los pacientes en tratamiento, cirugía, quimioterapia y radioterapia tienen niveles altos de cortisol que influye en su calidad de vida. OBJETIVO: Identificar la relación entre el estrés, a nivel de cortisol y las estrategias de afrontamiento en pacientes con cáncer sometidos a tratamiento. MATERIAL Y MÉTODOS: Estudio transversal, descriptivo y correlacional realizado junio a diciembre del 2019. RESULTADOS EPIDEMIOLÓGICOS: 68.2% mujeres 31.8 % hombres, entre 17 y 76 años, con diagnósticos de: Ca mama (30.3%), de próstata (18.3), colon (15.2), pulmón (13.6), cervical (12.1% gástrico (9.1%) cáncer de piel (1.5%). Estadísticos: El 35,3% informaron cortisol a niveles normales y 64.5% niveles altos; el estrés obtuvo un promedio de 13.9 (DE = 4.64). Sobre el nivel de cortisol y el tipo de tratamiento, se observaron diferencias significativas (X2 = 1,546, p = .04), es decir, el paciente que tienen un tratamiento mixto el cortisol es más alto. CONCLUSIONES: Es importante reevaluar las estrategias centradas en el problema, analizar implicaciones y proponer estudios en el contexto en que se desenvuelven, en futuro desarrollar una intervención incluyendo actividades de enfermería en la quimioterapia y radioterapia, apoyando estrategias de afrontamiento efectivas. En este sentido y derivado de la minimización de amenazas centradas en el problema, es importante tener un enfoque integral más profundo


INTRODUCTION: Cancer is one of the leading causes of morbidity and mortality worldwide, according to the World Health Organization (WHO), in 2012 14 million new cases and 8.2 million deaths. (WHO, 2019). Patients in treatment, surgery, chemotherapy and radiation therapy have been shown to have high levels of cortisol that influence their quality of life. OBJECTIVE: to identify the relationship between stress, cortisol level and coping strategies in cancer patients undergoing treatment. MATERIAL AND METHODS: Cross-sectional, descriptive and correlational study conducted June to December 2018. In 65 male and female patients under treatment. RESULTS: 68.2% were women 31.8% men, between 17 and 76 years. With diagnoses Ca breast (30.3%), prostate cancer (18.3), colon (15.2), lung (13.6), cervical (12.1% gastric (9.1%) skin cancer (1.5%). Statistics: 35.3% reported cortisol at normal levels and 64.5% high levels; stress averaged 13.9 (DE s 4.64). On the level of cortisol and the type of treatment, significant differences were observed (X2 X 1,546, p .04), i.e. the patient who has a mixed treatment cortisol is higher. CONCLUSIONS: It is important to reevaluate the strategies focused on the problem, analyze implications and propose studies in the context in which they operate, in the future develop an intervention including nursing activities in chemotherapy and radiotherapy, supporting effective coping strategies. minimizing threats focused on the problem, it is important to have a deeper comprehensive approach


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Hidrocortisona/análise , Estresse Psicológico/epidemiologia , Adaptação Psicológica/classificação , Neoplasias/psicologia , Síndrome de Adaptação Geral/epidemiologia , Estudos Transversais , Metástase Neoplásica/fisiopatologia , Radioterapia/psicologia , Tratamento Farmacológico/psicologia , Escalas de Graduação Psiquiátrica/estatística & dados numéricos
4.
Gynecol Endocrinol ; 36(9): 786-790, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31914838

RESUMO

Stress adaptation disorder exists in gestational diabetes mellitus (GDM) women, this study was to investigate the impact of stress adaptation disorder on glucose disposal and skeletal muscle glucose transporter4 (GLUT4) expression in GDM rat model. Rats were assigned randomly to Normal control (NC) group and GDM group. We analyzed the levels of corticosterone, epinephrine (E), norepinephrine (NE), malondialdehyde (MDA) and superoxide dismutase (SOD), interleukin-6 (IL-6) and expression of GLUT4 were also detected. Homeostasis model assessment (HOMA-IR) was used to evaluate insulin resistance. Compared with NC group, E, NE and Corticosterone were increased significantly, SOD and MDA were higher and GLUT4 expression was significantly lower in GDM rats. Corticosterone was positively related to MDA, MDA was positively and SOD was negatively related to HOMA-IR in both groups, IL-6 showed significant positive correlations with HOMA-IR. NE and Corticosterone were negative related to GLUT4 in GDM group. Stress hormones (E, NE and Corticosterone), MDA and IL-6 were the risk factors of GDM, SOD was the protective factor of GDM. Changes of stress hormones indicate that stress adaptation disorder exists in GDM rats. Stress adaptation disorder increase oxidative stress injury and inflammation, decrease GLUT4 and lead to incline of glucose uptake, result in hyperglycemia. Gaining an insight into correlations of these changes may be beneficial to maternal and child health and is important for the prevention of glycemia-related diseases.


Assuntos
Diabetes Gestacional/etiologia , Síndrome de Adaptação Geral/complicações , Transportador de Glucose Tipo 4/genética , Estresse Oxidativo/fisiologia , Animais , Glicemia/metabolismo , Corticosterona/metabolismo , Diabetes Gestacional/genética , Diabetes Gestacional/metabolismo , Modelos Animais de Doenças , Feminino , Síndrome de Adaptação Geral/genética , Síndrome de Adaptação Geral/metabolismo , Transportador de Glucose Tipo 4/fisiologia , Resistência à Insulina/fisiologia , Masculino , Gravidez , Ratos , Ratos Sprague-Dawley
5.
C R Biol ; 342(5-6): 136-141, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31501012

RESUMO

The impact of stressful conditions on immunity seems mixed and at times counterbalanced. Such inconsistencies can often be attributed to the fact that the notion of stress has a very wide meaning and covers a large number of different situations. Research on liver X receptors using both natural and synthetic ligands may help to solve this conflict. When an infectious agent is present in a stressed body, LXR activation is likely to be a key element in the regulation of POMC, IFN-γ, and IL-18; moreover, it is a unique anti-inflammatory mode of action. They concurrently stimulate a non-specific immune reaction as they suppress inflammatory and autoimmune processes.


Assuntos
Síndrome de Adaptação Geral/imunologia , Síndrome de Adaptação Geral/fisiopatologia , Receptores X do Fígado/imunologia , Animais , Doenças Autoimunes/imunologia , Doenças Autoimunes/fisiopatologia , Humanos , Inflamação/imunologia , Inflamação/fisiopatologia
6.
Georgian Med News ; (292-293): 102-108, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31560673

RESUMO

The article discusses the problems of the process of environmental adaptations appearance which are based on the general principles of functional systems' constitution. The value of the theory of functional systems development as the basis for physiological cybernetics (P. Anokhin, 1935) is also given. A general adaptation syndrome ("a stress - syndrome") that was discovered by H. Selye is chosen as an example to explain the development of the stages of the functional system of the stress, the sequence and value of ongoing physiological reactions and negative feedback interactions. The stress - syndrome reactions are the nonspecific response of a particular organism to various factors: emotional shock, trauma, infections, surgery, burns etc. The article also paid attention to the reasons and conditions for the failure of adaptations' emergence and the transformation of adaptive reactions into pathological ones. The key role of stress syndrome reactions as the main or auxiliary etiological factor in the development of coronary heart disease, hypertension, atherosclerosis, lesions of the stomach and duodenum, immunodeficiencies, etc. is indicated. To be effective in interactions with the environment, organisms have developed different mechanisms which are not only activating but also suppressing the excessive activity of the functional stress system that damages the organs. Therefore, the article considers the significance of negative feedback adaptations that act as stress - initiating and stress - limiting mechanisms.


Assuntos
Adaptação Fisiológica , Síndrome de Adaptação Geral , Estresse Fisiológico , Estresse Psicológico/fisiopatologia , Sistema Cardiovascular/fisiopatologia , Estresse Psicológico/complicações
7.
Inflamm Res ; 68(2): 177-180, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30456595

RESUMO

Hans Selye was an endocrinologist, a pioneer of research on biological stress in human individuals and groups. His most important scientific contributions include in 1936 the evidence that the pituitary-adrenal-thymus axis was activated by various nocuous stimuli, which led to the involution of the thymus and of the lymphoid organs; in 1946, the theory of general adaptation syndrome (GAS), pointing out that this is a general reaction that leads to resistance of the organism to various insults. This review article is focused on the general interest of Selye on the important role played by mast cells in different pathological conditions and in particular in calciphylaxis and calcergy, summarized in a classic book, which is a lasting contribution on the subject.


Assuntos
Calciofilaxia/patologia , Mastócitos/fisiologia , Fisiologia/história , Adaptação Fisiológica , Canadá , Síndrome de Adaptação Geral/história , História do Século XX , Humanos , Mastócitos/patologia
8.
Biol Res Nurs ; 20(5): 473-496, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29865855

RESUMO

PROBLEM: Incorporating biomarkers of chronic stress into pediatric research studies may help to explicate the links between exposure to adversity and lifelong health, but there are currently very few parameters to guide nurse researchers in choosing appropriate biomarkers of chronic stress for use in research with children and adolescents. METHODS: Biomarkers of chronic stress are described, including primary mediators (glucocorticoids, catecholamines, and cytokines) and secondary outcomes (neurologic, immune, metabolic, cardiovascular, respiratory, and anthropometric) of the chronic stress response. RESULTS: Evidence of the use of each biomarker in pediatric research studies is reviewed. Recommendations for pediatric researchers, including selection of appropriate biomarkers, measurement considerations, potential moderators, and future directions for research, are presented. DISCUSSION: A wide range of biomarkers is available for use in research studies with children. While primary mediators of chronic stress have been frequently measured in studies of children, measurement of secondary outcomes, particularly immune and metabolic biomarkers, has been limited. With thoughtful and theoretically based approaches to selection and measurement, these biomarkers present an important opportunity to further explore the physiologic pathways linking exposure to chronic stress with later health and disease. CONCLUSION: The incorporation of chronic stress biomarkers into pediatric research studies may provide valuable insight into the mechanisms through which stressful environments "get under the skin" and ultimately inform efforts to promote health and reduce inequities among children exposed to adversity.


Assuntos
Biomarcadores/análise , Pesquisa Biomédica/métodos , Doença Crônica , Síndrome de Adaptação Geral/fisiopatologia , Estresse Fisiológico/fisiologia , Estresse Psicológico/fisiopatologia , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Projetos de Pesquisa
11.
Med Hypotheses ; 113: 17-26, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29523287

RESUMO

We report on a new quantitative EEG-approach, called Ipsative Trend Assessment which is based on the spatio-temporally defined patterns which are generated by the global interaction of cortical neurons. METHODS: The data were acquired from EEGs being recorded under resting conditions. Target variables are not the usually employed absolute values of the spectral parameters but rather their change being calculated from successive recordings with a single subjects design. RATIONALE: Since the resting-EEG does not provide specific information, we had to decide what else might be addressed by that method. CONCLUSIONS: Our hypothesis according to which the SR-EEG indicates Selye's behaviorally non-specific General Adaptation Syndrome is based on good evidence. MAIN FINDINGS: Dynamic pattern comparison between subsequent EEGs on the single case level is a hitherto neglected method, which may be utilize, for instance, with regard to objective therapeutic outcome assessment. SIGNIFICANCE: In order to substantiate the clinical meaningfulness of our new approach we report two case vignettes of psychiatric impairments. Apart from that, our procedure should provide the desperately needed objective assessment of the therapeutic effect with any disease displaying a certain proportion of unspecific symptoms.


Assuntos
Eletroencefalografia/métodos , Neurônios/fisiologia , Alcoolismo/fisiopatologia , Transtorno Bipolar/fisiopatologia , Encéfalo/fisiopatologia , Síndrome de Adaptação Geral/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Teóricos , Descanso , Processamento de Sinais Assistido por Computador , Software , Fatores de Tempo
12.
Sports Med ; 48(4): 787-797, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29307100

RESUMO

Recent reviews have attempted to refute the efficacy of applying Selye's general adaptation syndrome (GAS) as a conceptual framework for the training process. Furthermore, the criticisms involved are regularly used as the basis for arguments against the periodization of training. However, these perspectives fail to consider the entirety of Selye's work, the evolution of his model, and the broad applications he proposed. While it is reasonable to critically evaluate any paradigm, critics of the GAS have yet to dismantle the link between stress and adaptation. Disturbance to the state of an organism is the driving force for biological adaptation, which is the central thesis of the GAS model and the primary basis for its application to the athlete's training process. Despite its imprecisions, the GAS has proven to be an instructive framework for understanding the mechanistic process of providing a training stimulus to induce specific adaptations that result in functional enhancements. Pioneers of modern periodization have used the GAS as a framework for the management of stress and fatigue to direct adaptation during sports training. Updates to the periodization concept have retained its founding constructs while explicitly calling for scientifically based, evidence-driven practice suited to the individual. Thus, the purpose of this review is to provide greater clarity on how the GAS serves as an appropriate mechanistic model to conceptualize the periodization of training.


Assuntos
Adaptação Fisiológica , Síndrome de Adaptação Geral , Periodicidade , Estresse Fisiológico , Humanos , Esportes
14.
J Clin Psychol Med Settings ; 24(3-4): 316-340, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28756504

RESUMO

This integrative literature review uses cognitive analytic therapy (CAT) theory to examine the impact of a chronic illness, multiple sclerosis (MS), on relationships and mental health. Electronic searches were conducted in six medical and social science databases. Thirty-eight articles met inclusion criteria, and also satisfied quality criteria. Articles revealed that MS-related demands change care needs and alter relationships. Using a CAT framework, the MS literature was analysed, and five key patterns of relating to oneself and to others were identified. A diagrammatic formulation is proposed that interconnects these patterns with wellbeing and suggests potential "exits" to improve mental health, for example, assisting families to minimise overprotection. Application of CAT analysis to the literature clarifies relational processes that may affect mental health among individuals with MS, which hopefully will inform how services assist in reducing unhelpful patterns and improve coping. Further investigation of the identified patterns is needed.


Assuntos
Terapia Cognitivo-Comportamental , Relações Interpessoais , Esclerose Múltipla/psicologia , Atividades Cotidianas/classificação , Avaliação da Deficiência , Síndrome de Adaptação Geral , Humanos , Teoria Psicológica , Qualidade de Vida
15.
Curr Pharm Des ; 23(27): 4029-4041, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28641541

RESUMO

The first scientific publication on 'general adaption syndrome', or as we know today 'biologic stress' has been published in Nature in 1936 by the 29-year old Hans Selye. His results in that short publication that contained no references or illustrations, were based on experiments in rats that were exposed to severe insults/ stressors, but his idea about a 'nonspecific bodily response' originated from his observations of sick patients whom he had seen as a medical student and young clinician. Autopsy of stressed rats revealed three major, grossly visible changes: hyperemia and enlargement of the adrenals, atrophy of the thymus and lymph nodes as well as hemorrhagic gastric erosions/ulcers (the "stress triad"). Based on this and additional observations, he concluded that the key master organ in stress reactions is the adrenal cortex (although he also accepted the limited and short lasting effect of catecholamines released from the adrenal medulla) which stimulated by an increased secretion of ACTH, secreted by the anterior pituitary gland. He thus identified the first molecular mediators of the stress reaction, i.e., steroids released from the adrenal cortex that we call today glucocorticoids, based on his classification and naming of steroids. At the end of a very productive life in experimental medicine, Selye recognized that under both unpleasant and demanding stressors as well as positive, rewarding stimuli adrenal cortex releases the same glucocorticoids and only certain brain structures may distinguish the stimuli under distress and eustress - terms he introduced in 1974, that also contained his last definition of stress: the nonspecific response of the body on any demand on it. After brief description of the history of stress research, the rest of this review is focused on one element of stress triad, i.e., gastroduodenal ulceration, especially its pathogenesis, prevention and treatment. Following a short description of acute gastroprotection, discovered by one of Selye's students, we discuss new molecular mediators of gastroduodenal ulceration like dopamine and new drugs that either only heal (very potently, on molar basis) or prevent and heal ulcers like sucralfate derivatives and the relatively new peptide BPC-157. We conclude that despite the extensive and multidisciplinary research on stress during the last 80 years, a lot of basic and clinical research is needed to better understand the manifestations, central and peripheral molecular regulators of stress response, especially the modes of prevention/management of distress or its transformation into eustress and the treatment of stress-related diseases.


Assuntos
Síndrome de Adaptação Geral/história , Úlcera Péptica/história , Estresse Fisiológico/fisiologia , Córtex Suprarrenal/metabolismo , Animais , Modelos Animais de Doenças , Síndrome de Adaptação Geral/fisiopatologia , Glucocorticoides/metabolismo , História do Século XX , Humanos , Ratos
16.
J Sci Med Sport ; 20(11): 1015-1017, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28377133

RESUMO

Within the resistance training literature, one of the most commonly cited tenets with respect to exercise programming is the "General Adaptation Syndrome" (GAS). The GAS is cited as a central theory behind the periodization of resistance exercise. However, after examining the original stress research by Hans Selye, the applications of GAS to resistance exercise may not be appropriate. OBJECTIVES: To examine the original work of Hans Selye, as well as the original papers through which the GAS was established as a central theory for periodized resistance exercise. METHODS: We conducted a review of Selye's work on the GAS, as well as the foundational papers through which this concept was applied to resistance exercise. RESULTS/CONCLUSIONS: The work of Hans Selye focused on the universal physiological stress responses noted upon exposure to toxic levels of a variety of pharmacological agents and stimuli. The extrapolations that have been made to resistance exercise appear loosely based on this concept and may not be an appropriate basis for application of the GAS to resistance exercise.


Assuntos
Síndrome de Adaptação Geral/etiologia , Treinamento de Força/efeitos adversos , Estresse Fisiológico , Humanos , Esportes/psicologia
17.
Curr Pharm Des ; 23(27): 4012-4028, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28228068

RESUMO

Selye's syndrome produced by diverse nocuous agents and "response to damage as such" means Selye's stress triad in stress coping response to reestablish homeostasis. Logically, from the gastrointestinal tract viewpoint, such organoprotective/healing response implies the angiogenic growth factors that commonly signify the healing. Thereby, the gastric pentadecapeptide BPC 157-organoprotection (huge range of beneficial effects) signifies the Selye's stress concept/stress coping response implemented in and from gastrointestinal tract, and BPC 157 as an integrative mediator that integrates the adaptive bodily response to stress. In clinical trials without side effects, LD1 not achieved, BPC 157 healing in gastrointestinal tract, and particularly the healing of the extragastrointestinal tissues (i.e., skin/tendon/ligament/muscle/bone; nerve; cornea/ brain) were referred throughout its integrative capabilities (i.e., ulcerative colitis/multiple sclerosis model equally counteracted), native in gastrointestinal tract, stability in human gastric juice (and thereby, strong efficacy and applicability), its relevance for dopamine-system function (and thereby, counteracting effects of dopamine-system dysfunction and overfunction, centrally and peripherally (mucosa maintenance); interaction with serotonin- and GABA-system)), afforded cytoprotection/adaptive cytoprotection/organoprotection (and thereby, beneficial effects on gastric and whole intestinal tract lesions and adaptation, wounds and fistulas healing, blood vessels, somatosensory neurons, NSAIDs-side effects (including also pancreas, liver, brain lesions, and blood disturbances, prolonged bleeding, thrombocytopenia, thrombosis)). Further, we combine such gut-brain axis and the NO-system where BPC 157 counteracts complications of either L-NAME application (i.e., various lesions aggravation, hypertension) or Larginine application (i.e., hypotension, prolonged bleeding, thrombocytopenia). Also, BPC 157 particularly affects genes functions (i.e., Fos, c-Jun, Egr-1), all together suggestive for an indicative generalization. Thus, we could suggest gastric pentadecapeptide BPC 157 and BPC 157 induced-organoprotection as integrative mediator that integrates the adaptive bodily response to stress, and thereby practically applied in further therapy and in effective realization of Selye's stress response.


Assuntos
Trato Gastrointestinal/fisiopatologia , Síndrome de Adaptação Geral/fisiopatologia , Estresse Fisiológico/fisiologia , Adaptação Fisiológica/fisiologia , Animais , Anti-Inflamatórios não Esteroides/administração & dosagem , Anti-Inflamatórios não Esteroides/efeitos adversos , Dopamina/metabolismo , Humanos , NG-Nitroarginina Metil Éster/farmacologia , Fragmentos de Peptídeos/metabolismo , Proteínas/metabolismo
18.
In. Capezzuto Castro, Beatriz; Garay Albarracin, Margarita; Castrillón de Freitas, Sebastián; Chávez Grimaldi, Gabriel; Díaz Ocampo, Álvaro. Estrés laboral: síndrome de burnout y mobbing en el equipo de salud: aspectos psicológicos. Montevideo, UdelaR. Ediciones Universitarias, 2017. p.29-33.
Monografia em Espanhol | LILACS, BNUY, UY-BNMED | ID: biblio-1372860
19.
Neurotoxicol Teratol ; 54: 5-14, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26791321

RESUMO

OBJECTIVES: To evaluate adaptive behavior outcomes of children prenatally exposed to lamotrigine, valproate, or carbamazepine, and to determine if these outcomes were dose-dependent. METHODS: Data were collected from women enrolled in the North American Anti epileptic Drug (AED) Pregnancy Registry who had taken lamotrigine, valproate, or carbamazepine monotherapies throughout pregnancy to suppress seizures. The adaptive behavior of 252 exposed children (including 104 lamotrigine-exposed, 97 carbamazepine-exposed, and 51 valproate-exposed), ages 3- to 6-years-old, was measured using the Vineland-II Adaptive Behavior Scales, administered to each mother by telephone. Mean Adaptive Behavior Composite (ABC), domain standard scores for communication, daily living, socialization and motor skills, and adaptive levels were analyzed and correlated with first trimester drug dose. RESULTS: After adjusting for maternal age, education, folate use, cigarette and alcohol exposure, gestational age, and birth weight by propensity score analysis, the mean ABC score for valproate-exposed children was 95.6 (95% CI [91, 101]), versus 100.8 (95% CI [98, 103]) and 103.5 (95% CI [101, 106]) for carbamazepine- and lamotrigine-exposed children, respectively (ANOVA; p=0.017). Significant differences were observed among the three drug groups in the ABC (p=0.017), socialization (p=0.026), and motor (p=0.018) domains, with a trend toward significance in the communication domain (p=0.053). Valproate-exposed children scored lowest and lamotrigine-exposed children scored highest in every category. Valproate-exposed children were most likely to perform at a low or moderately low adaptive level in each category. Higher valproate dose was associated with significantly lower ABC (p=0.020), socialization (p=0.009), and motor (p=0.041) scores before adjusting for confounders. After adjusting for the above variables, increasing VPA dose was associated with decreasing Vineland scores in all domains, but the relationships were not statistically significant. No dose effect was observed for carbamazepine or lamotrigine. CONCLUSIONS: Unlike carbamazepine and lamotrigine, prenatal valproate exposure was associated with adaptive behavior impairments with specific deficits in socialization and motor function, along with a relative weakness in communication. Increasing valproate dose was associated with a decline in adaptive functioning. This finding of a linear dose-dependent teratogenic effect suggests that valproate should be avoided at any dose during pregnancy. However, some women with epilepsy controlled only by valproate will decide, in consultation with their provider, that the benefits of continuing valproate during pregnancy outweigh the fetal risks. Faced with difficult choices, clinicians should be supportive as these patients consider their options.


Assuntos
Anticonvulsivantes/efeitos adversos , Deficiências do Desenvolvimento/etiologia , Síndrome de Adaptação Geral/etiologia , Complicações na Gravidez/induzido quimicamente , Efeitos Tardios da Exposição Pré-Natal/fisiopatologia , Efeitos Tardios da Exposição Pré-Natal/psicologia , Análise de Variância , Carbamazepina , Criança , Pré-Escolar , Epilepsia/tratamento farmacológico , Feminino , Humanos , Lamotrigina , Masculino , Gravidez , Efeitos Tardios da Exposição Pré-Natal/induzido quimicamente , Triazinas , Ácido Valproico
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