Prevalência de transtornos do humor em indivíduos com doença renal crônica e impacto na qualidade de vida: revisão sistemática de literatura / Prevalence of mood disorders in individuals with chronic kidney disease and impact on quality of life: a systematic literature review / Prevalencia de trastornos del estado de ánimo en individuos con enfermedad renal crónica e impacto en la calidad de vida: revisión sistemática de la literatura

A doença renal crônica (DRC) é um problema global de saúde pública. Em países desenvolvidos, a prevalência fica entre 10 e 13% da população adulta. Já em países em desenvolvimento, os dados de prevalência são bastante limitados. Trata-se de uma comorbidade com implicações importantes em qualidade de vida, relacionada ao desenvolvimento de distúrbios do humor, principalmente transtorno depressivo. O objetivo deste trabalho é compreender como se dá a experiência de adoecimento de pessoas com doença renal crônica e o desenvolvimento dos sintomas depressivos, a fim de entender como essa doença interfere na qualidade de vida do indivíduo, além estabelecer a prevalência de distúrbios do humor, como depressão e ansiedade, nessa população. Este estudo é uma revisão sistemática da literatura acerca da frequência dos transtornos de humor em indivíduos com DRC, baseada nos critérios do PRISMA-P. Foram incluídos estudos observacionais transversais e longitudinais, bem como pesquisas de séries de casos publicados nos últimos dez anos. Inicialmente, foram selecionados 28 artigos por títulos. Após leitura de resumos e aplicação dos critérios de inclusão, foram selecionados nove artigos, que foram lidos na íntegra. Após essa etapa, foram excluídos dois, restando, portanto, sete estudos. Os principais desfechos foram depressão, ansiedade e redução na qualidade de vida em indivíduos acometidos por doença renal crônica terminal. A frequência de transtornos mentais, sobretudo depressão e ansiedade, é maior em doentes renais crônicos em comparação à população geral. Logo, torna-se necessária a criação de políticas públicas voltadas para melhoria da qualidade de vida, além do suporte em saúde mental adequado, a fim de minimizar a vulnerabilidade identificada nessa população.

Chronic kidney disease (CKD) is a global public health issue, reaching a prevalence of 10-13% among the adult population in developed countries. Conversely, data on CKD prevalence in developing countries is scarce. Given the impacts of this comorbidity in quality of life and association with the development of mood disorders, especially major depressive disorder, this study sought to investigate how individuals with CKD experience illness and the development of depressive symptoms, to understand how this disease interferes in quality of life, as well as to establish the prevalence of psychological disorders, such as depression, in this population. This systematic literature review on the prevalence of mood disorders in individuals with CKD followed the PRISMA-P criteria. Cross-sectional, longitudinal observational studies and case series studies published in the last 10 years were included. A total of 28 articles were selected by titles, of which nine remained after reading the abstracts and applying the inclusion criteria. These were read in full, and two more were excluded, resulting in seven studies included for review. Main outcomes were depression, anxiety, and reduced quality of life in individuals with end-stage CKD. Prevalence of mental disorders, especially depression and anxiety, is higher in CKD patients compared to the general population. Thus, public policies aimed at improving quality of life and adequate mental health support are needed to minimize vulnerability in this population.

La enfermedad renal crónica (ERC) es un problema de salud pública mundial. En los países desarrollados la prevalencia está entre el 10 y el 13% de la población adulta. Sin embargo, en los países en desarrollo, los datos de prevalencia son bastante limitados. Esta es una comorbilidad con importantes implicaciones en la calidad de vida y está relacionada con el desarrollo de trastornos del estado de ánimo, especialmente el trastorno depresivo. El objetivo de este estudio es conocer cómo las personas con enfermedad renal crónica experimentan la enfermedad y el desarrollo de síntomas depresivos, para comprender la interferencia de esta enfermedad en la calidad de vida del individuo, además de establecer la prevalencia de trastornos del estado de ánimo, tales como depresión y ansiedad en la población en cuestión. Este estudio es una revisión sistemática de la literatura sobre la frecuencia de trastorno del estado de ánimo en personas con ERC, con base en los criterios del PRISMA-P. Se incluyeron a estudios observacionales, transversales y longitudinales, así como investigaciones de series de casos que habían sido publicadas en los últimos diez años. Inicialmente se seleccionaron 28 artículos por títulos. Realizada la lectura de los resúmenes y aplicados los criterios de inclusión, se seleccionaron nueve artículos, los cuales fueron leídos en su totalidad. Después, se excluyeron nueve, quedando siete estudios. Los resultados principales fueron depresión, ansiedad y reducción de la calidad de vida en pacientes con enfermedad renal en etapa terminal. La frecuencia de trastornos mentales, especialmente depresión y ansiedad, es mayor en la enfermedad renal crónica en comparación con la población general. Por lo tanto, se hace necesaria la creación de políticas públicas para mejorar la calidad de vida y el adecuado apoyo a la salud mental, con el fin de minimizar la vulnerabilidad en esta población.

Evaluation of mood disorder questionnaire positivity and associated factors in a population-based screening study

The Mood Disorders Questionnaire (MDQ) is a 3-item scale that is frequently used in bipolar disorders (BD) screening and questions the symptoms of BD, its effect on functionality, and the coexistence of symptoms. The aim of this study is to evaluate the prevalence of positive screening of the MDQ among general population and to investigate the associated risk factors. In this cross-sectional study, the sample was randomly selected from household data to represent the city population. A total of 432 participants were asked to fill in MDQ, CAGE (cutting down, annoyance by criticism, guilty feeling, and eye-openers) questionnaire, which consists of four clinical interview questions proven to aid in the diagnosis of alcoholism, and clinical and sociodemographic data form. The Cronbach's alpha value of our current study was 0.813 for MDQ. The prevalence of MDQ positivity was found 7.6%. The estimated prevalence rate of bipolar disorders varied between 0.3 and 13.4% according to different cut-off values. Multivariate logistic regression models showed that the presence of possible alcohol addiction, shift work history, and body mass index (BMI) were statistically significant predictors of MDQ positivity. The prevalence of MDQ positivity found is similar to studies in literature. Keeping in mind that psychometric properties of the MDQ, positive screen results should be cautiously interpreted due to the presence of other risk factors and comorbidities. (AU)

Determinants of self-efficacy in patients with Parkinson's disease / Determinantes de autoeficacia en pacientes con enfermedad de Parkinson

ABSTRACT Background: Self-efficacy is the individual's assessment of his or hers ability to complete a specific task successfully and has been closely related to self-management and quality of life in several diseases. Objective: To investigate self-efficacy in a population of Parkinson's disease (PD) patients in Mexico and study the factors that are associated with this measure. Methods: We carried out a cross-sectional observational study involving patients with PD in an outpatient neurology clinic in Mexico, using the following instruments: Spanish version of the Chronic Disease Self-Efficacy Scale (CDSES), Quality of Life Questionnaire PDQ-8, Movement Disorders Society-Unified Parkinson's disease Rating Scale (MDS-UPDRS), Montreal Cognitive Assessment (MoCA), and Non-Motor Symptom Scale (NMSS). Clinical and demographic variables were also recorded. Results: We included 73 patients with a mean age of 65 years and most patients were male. Patients with lower CDSES scores (<7.75) had worse scores in MDS-UPDRS, NMSS, and PDQ-8 scales. CDSES scores were significantly correlated with MDS-UPDRS Part I (r=-0.497, p=<0.001), Part II (r= -0.271, p=0.020), Part III (r=-0.304, p=<0.001), PDQ-8 (r=-0.472, p=<0.001), and NMSS (r=-0.504, p=<0.001). Furthermore, when assessing the simultaneous effect of covariates associated with CDSES score, only Mood/Apathy domain of NMSS was significant (beta= -0.446, t= -3.807, p= 0.012). Conclusions: PD patients with lower self-efficacy scores had worse motor and non-motor symptomatology and quality of life. Mood/Apathy disorders were negatively associated with self-efficacy and contributed significantly to this measure.

RESUMEN Antecedentes: La autoeficacia es la autoevaluación de un individuo sobre su capacidad para completar una tarea con éxito y se ha relacionado con automanejo y calidad de vida en otras enfermedades. Objetivo: Investigar la autoeficacia en una población de pacientes con enfermedad de Parkinson (EP) en México y estudiar factores asociados con esta medida. Métodos: Realizamos un estudio observacional transversal con pacientes con EP en una clínica de neurología en México. Se registraron datos demográficos y escalas que evalúan la función motora (MDS-UPDRS), no motora (NMSS) y cognitiva (MoCA), así como la calidad de vida (PDQ-8). Para valorar autoeficacia se utilizó la versión en español de la Escala de autoeficacia de enfermedades crónicas (CDSES). Resultados: Se incluyeron 73 pacientes, con una edad media de 65 años y la mayoría eran hombres. Pacientes con puntajes CDSES más bajos (<7.75) tuvieron peores puntajes en las escalas MDS-UPDRS, NMSS y PDQ-8. Las puntuaciones de CDSES se correlacionaron significativamente con la escala MDS-UPDRS Parte I (r=-0.497, p=<0.001), Parte II (r= -0.271, p=0.020), Parte III (r=-0.304, p=<0.001), PDQ-8 (r= -0.472, p=<0.001), y NMSS (r=-0.504, p=<0.001). Al evaluar el efecto simultáneo de covariables asociadas con la escala CDSES, solo el dominio estado de ánimo/apatía del NMSS resultó significativo (Beta = -0.449, t = -3.783, p = <0.001). Conclusiones: Los pacientes con menores puntajes de autoeficacia tienen peor calidad de vida y sintomatología motora y no motora. Los trastornos del estado de ánimo contribuyen negativamente a la autoeficacia.

Systematic review: Symptoms of parental depression and anxiety and offspring overweight / Revisão sistemática: Sintomas de depressão e ansiedade parental e excesso de peso da prole

ABSTRACT OBJECTIVE To evaluate the existing literature on the association between parents' depression and anxiety and their influence on their children's weight during childhood, identifying possible mechanisms involved in this association. METHODS A systematic search of the literature was conducted in the PubMed, PsycINFO and SciELO databases, using the following descriptors: (maternal OR mother* OR parent* OR paternal OR father) AND ("common mental disorder" OR "mental health" OR "mental disorder" OR "depressive disorder" OR depress* OR anxiety OR "anxiety disorder") AND (child* OR pediatric OR offspring) AND (overweight OR obes* OR "body mass index" OR BMI). A total of 1,187 articles were found after peer selection. RESULTS In total, 16 articles that met the inclusion criteria were selected for the review. Most of them investigated depressive symptoms and only three, symptoms of maternal anxiety. The evaluated studies suggested a positive association between symptoms of maternal depression and higher risk of childhood obesity. The results diverged according to the chronicity of depressive symptoms (episodic or recurrent depression) and income of the investigated country (high or middle income). Mechanisms were identified passing by quality of parenthood, affecting behaviors related to physical activity and child-feeding, as mediators of the association. CONCLUSIONS We conclude there is evidence of a positive relationship between the occurrence of maternal symptoms of depression and anxiety and childhood obesity. It is emphasized the need for a better understanding on the effect of depressive symptoms and the contextual factors involved in this relationship so that effective intervention strategies can be implemented.

RESUMO OBJETIVO Avaliar a literatura existente acerca da associação entre depressão e ansiedade dos pais e sua influência no excesso de peso dos filhos durante a infância, identificando possíveis mecanismos envolvidos nessa associação. MÉTODOS Foi realizada uma busca na literatura, de forma sistemática, nas bases de dados PubMed, PsycINFO e SciELO, usando os descritores: (maternal OR mother* OR parent* OR paternal OR father) AND ("common mental disorder" OR "mental health" OR "mental disorder" OR "depressive disorder" OR depress* OR anxiety OR "anxiety disorder") AND (child* OR pediatric OR offspring) AND (overweight OR obes* OR "body mass index" OR BMI). Foram encontrados 1.187 artigos após seleção por pares. RESULTADOS Foram selecionados 16 artigos que atingiram os critérios para inclusão na revisão. A maioria investigou sintomas depressivos e somente três, sintomas ansiosos maternos. Os estudos avaliados mostraram resultados sugestivos de associação positiva entre sintomas de depressão materna e maior risco de excesso de peso nos filhos. Os resultados divergiram de acordo com a cronicidade dos sintomas depressivos (depressão episódica ou recorrente) e renda do país investigado (alta ou média renda). Foram identificados mecanismos que passam pela qualidade da parentalidade, afetando comportamentos relacionados à atividade física e alimentação da criança, como mediadores da associação. CONCLUSÕES Concluímos que há evidências de uma relação positiva entre a ocorrência de sintomas maternos de depressão e ansiedade e o excesso de peso dos filhos. Ressalta-se a necessidade de uma melhor compreensão do impacto do momento de ocorrência dos sintomas depressivos e dos fatores contextuais envolvidos nessa relação para que possam ser implementadas estratégias de intervenção eficazes.

Sociodemographic, behavioral, and health-related risk factors for depression among men and women in a southern Brazilian city

Objective: To assess the prevalence of depression and sociodemographic, behavioral, and health-related risk factors therefor in a southern Brazilian city. Methods: Population-based, cross-sectional study of adults from Rio Grande, state of Rio Grande do Sul, Brazil. Individuals (n=1,295) were selected using a multistage sampling procedure. The Patient Health Questionnaire-9 (PHQ-9) was used to screen for major depressive episodes (MDEs). We used a conceptual causal framework to organize and assess risk factors for MDE and calculated prevalence ratios (PR) using regression models. Results: The prevalence of MDE was 8.4% (95%CI 6.0-10.7) for men and 13.4% (95%CI 11.0-15.8) for women. For men, physical inactivity (PR 2.34, 95%CI 1.09-5.00) and perceived stress (PR 20.35, 95%CI 5.92-69.96) were associated with MDE. In women, MDE prevalence was higher among those in the first tertile of economic index (PR 2.61, 95%CI 1.53-4.45), with 0-8 years of schooling (PR 2.25, 95%CI 1.24-4.11), alcohol users (PR 1.91, 95%CI 1.21-3.02), those physically inactive (PR 2.49, 95%CI 1.22-5.09), with the highest perceived stress (PR 9.17, 95%CI 3.47-24.23), with another mental disorder (PR 1.85, 95%CI 1.32-2.59), and with more noncommunicable diseases (PR 1.85, 95%CI 1.06-3.22). Conclusion: Women had a higher prevalence of depression, and socioeconomic disadvantages were important for the occurrence of MDE; however, for men, only physical inactivity and stress were important predictors, suggesting possible different causal pathways for each sex.

Suicide risk configuration system in a clustered clinical sample: a generalized linear model obtained through the LASSO technique

Objective: To identify clinical and sociodemographic factors that increase or decrease suicidal risk in a clinical sample of subjects seeking mental health care. Method: A cross-sectional study was performed at three health centers in Santiago, Chile. The Parental Bonding Instrument (PBI), Depressive Experience Questionnaire (DEQ), Outcome Questionnaire (OQ-45.2), Reasons for Living Inventory (RFL), and State Trait Anger Expression Inventory (STAXI-2), in addition to a sociodemographic survey, were applied to 544 participants (333 with suicidal behavior and 211 without current suicidal behavior). Through hierarchical clustering analysis, participants were grouped by similarity regarding suicidal risk. Then, a regression analysis was performed using the Least Absolute Shrinkage and Selection Operator (LASSO) technique, and factors that decrease or increase suicide risk (SR) were identified for each cluster. Results: The resultant clusters were grouped mainly by the age of participants. The most important protective factor was having confidence in one's own coping skills in difficult situations. Relevant risk factors were major depressive disorder (MDD), poor anger management, and difficulties in interpersonal relationships. Conclusions: Suicidal risk manifests differently throughout the life cycle, and different types of bonds may protect from or increase risk of suicide.

Metabolic syndrome and psychiatric disorders: a population-based study

Objective: To identify the association of metabolic syndrome (MetS) and psychiatric disorders in young adults in southern Brazil. Methods: This population based cross-sectional study involved a total of 1,023 young adults between the ages of 21 and 32 years. Current episodes of psychiatric disorders were assessed using the Mini International Neuropsychiatric Interview - Plus version. MetS was evaluated using the National Cholesterol Education Program Adult Treatment Panel III (NCEP/ATP III). Results: Of the 1,023 participants, 24.3% were identified with MetS, 13.5% were diagnosed with anxiety disorders, 7.5% with current depression, 3.9% with bipolar disorders and 10.1% were at risk of suicide. MetS was associated with ethnicity (p = 0.022), excess weight (p < 0.001), current anxiety disorders (p < 0.001), current mood disorders (bipolar disorder in mood episode and current depression) (p < 0.001), and suicide risk (p < 0.001). Conclusions: MetS was associated with psychiatric disorders. Awareness of factors associated with MetS can help identify high-risk individuals and stimulate disease prevention and control programs, as well as lifestyle changes.

Effectiveness evaluation of mood disorder treatment algorithms in Brazilian public healthcare patients

Objective: To assess the effectiveness of three mood disorder treatment algorithms in a sample of patients seeking care in the Brazilian public healthcare system. Methods: A randomized pragmatic trial was conducted with an algorithm developed for treating episodes of major depressive disorder (MDD), bipolar depressive episodes and mixed episodes of bipolar disorder (BD). Results: The sample consisted of 259 subjects diagnosed with BD or MDD (DSM-IV-TR). After the onset of symptoms, the first treatment occurred ∼6 years and the use of mood stabilizers began ∼12 years. All proposed algorithms were effective, with response rates around 80%. The majority of the subjects took 20 weeks to obtain a therapeutic response. Conclusions: The algorithms were effective with the medications available through the Brazilian Unified Health System. Because therapeutic response was achieved in most subjects by 20 weeks, a follow-up period longer than 12 weeks may be required to confirm adequate response to treatment. Remission of symptoms is still the main desired outcome. Subjects who achieved remission recovered more rapidly and remained more stable over time. Clinical trial registration: NCT02901249, NCT02870283, NCT02918097

Validation of the Brazilian Portuguese version of the Premenstrual Symptoms Screening Tool (PSST) and association of PSST scores with health-related quality of life

Objective: To develop and validate a Brazilian Portuguese version of the Premenstrual Symptoms Screening Tool (PSST), a questionnaire used for the screening of premenstrual syndrome (PMS) and of the most severe form of PMS, premenstrual dysphoric disorder (PMDD). The PSST also rates the impact of premenstrual symptoms on daily activities. Methods: A consecutive sample of 801 women aged ≥ 18 years completed the study protocol. The internal consistency, test-retest reliability, and content validity of the Brazilian PSST were determined. The independent association of a positive screen for PMS or PMDD and quality of life determined by the World Health Organization Quality of Life instrument-Abbreviated version (WHOQOL-Bref) was also assessed. Results: Of 801 participants, 132 (16.5%) had a positive screening for PMDD. The Brazilian PSST had adequate internal consistency (Cronbach’s alpha = 0.91) and test-retest reliability. The PSST also had adequate convergent/discriminant validity, without redundancy. Content validity ratio and content validity index were 0.61 and 0.94 respectively. Finally, a positive screen for PMS/PMDD was associated with worse WHOQOL-Bref scores. Conclusions: These findings suggest that PSST is a reliable and valid instrument to screen for PMS/PMDD in Brazilian women.

Suicide detection in Chile: proposing a predictive model for suicide risk in a clinical sample of patients with mood disorders

Objective: To analyze suicidal behavior and build a predictive model for suicide risk using data mining (DM) analysis. Methods: A study of 707 Chilean mental health patients (with and without suicide risk) was carried out across three healthcare centers in the Metropolitan Region of Santiago, Chile. Three hundred forty-three variables were studied using five questionnaires. DM and machine-learning tools were used via the support vector machine technique. Results: The model selected 22 variables that, depending on the circumstances in which they all occur, define whether a person belongs in a suicide risk zone (accuracy = 0.78, sensitivity = 0.77, and specificity = 0.79). Being in a suicide risk zone means patients are more vulnerable to suicide attempts or are thinking about suicide. The interrelationship between these variables is highly nonlinear, and it is interesting to note the particular ways in which they are configured for each case. The model shows that the variables of a suicide risk zone are related to individual unrest, personal satisfaction, and reasons for living, particularly those related to beliefs in one’s own capacities and coping abilities. Conclusion: These variables can be used to create an assessment tool and enables us to identify individual risk and protective factors. This may also contribute to therapeutic intervention by strengthening feelings of personal well-being and reasons for staying alive. Our results prompted the design of a new clinical tool, which is fast and easy to use and aids in evaluating the trajectory of suicide risk at a given moment.

Prevalencia de trastornos del afecto y de ansiedad en personas con condiciones crónicas. Resultado de la Encuesta Nacional de Salud Mental Colombia 2015 / Prevalence of Mood and Anxiety Disorders on People with Chronic Conditions. Results from the National Mental Health Survey in Colombia 2015

Resumen Introducción: El estudio de trastornos mentales en personas con condiciones crónicas busca reconocer la importancia de buscarlos activamente y tratarlos, dado que las condiciones crónicas tienen mayor prevalencia de trastornos mentales y su comorbilidad genera una carga mayor que la suma de las que cada uno genera. Objetivos: Medir la prevalencia de trastornos del afecto y de ansiedad en la población colombiana de 12 años en adelante sin y con diferentes condiciones crónicas. Métodos: La información analizada corresponde a las observaciones de la Encuesta Nacional de Salud Mental 2015, que consideró un diseño de corte transversal con representatividad nacional y de los grupos de edad de 12-17, 18-44 y ≥ 45 años. Se miden los trastornos del afecto, además de fobia social, ansiedad generalizada y trastorno de pánico, además de diferentes condiciones crónicas. Todas las prevalencias corresponden a los últimos 12 meses. El análisis de resultados incluyó técnicas de tipo univariable y bivariable de estas condiciones, considerando el diseño de muestras complejas utilizado, es decir, los resultados que se presentan se extrapolan a la población colombiana en estudio. Resultados: Las personas con enfermedades del aparato gastrointestinal presentan la mayor prevalencia de trastornos del afecto o de ansiedad, seguidas de las que tienen dolor crónico o enfermedades cardiacas y pulmonares, con prevalencias del 27,1, el 13,3, el 12,2 y el 11,5% de los grupos de 18-44 años y el 15,9, el 12,2, el 8,0 y el 7,4% del ≥ 45 años mayor que la prevalencia de esos trastornos mentales en las personas sin ninguna condición crónica (el 3,5% del grupo más joven y el 1,1% de los mayores). Sin embargo, el riesgo de sufrir trastornos mentales es mayor para las personas de más edad; para los que tienen enfermedades gastrointestinales, la prevalencia es 14,9 veces la de las personas de la misma edad sin ninguna condición crónica, pero con la misma enfermedad es 7,8 veces la del grupo más joven. Conclusiones: Los hallazgos relacionan las condiciones crónicas con mayor prevalencia de trastornos mentales; en el presente estudio se resalta que son las personas de más edad quienes presentan la mayor comorbilidad.

Abstract Introduction: The study of mental disorders in people with chronic conditions recognises the importance of actively seeking and treating both, since chronic conditions have a higher prevalence than mental disorders and their comorbidity generates greater burden than if each one was considered separately. Objectives: To measure the prevalence of mood disorders and anxiety in a Colombian population of 12 years and older and with and without different chronic conditions. Methods: The information is taken from the National Mental Health Survey 2015 in Colombia, which was an observational cross-sectional study with national representativeness for the age groups measured 12-17, 18-44, and 45 and older. Disorders measured where mood disorders and anxiety social phobia, generalised anxiety disorder, and panic disorder in the past 12 months, and several chronic conditions. Univariate and bivariate analyses were performed for these conditions. Results: The highest prevalence of mood and anxiety disorders were found in people with gastrointestinal diseases, followed by those with chronic pain, heart, and lung diseases, which corresponded to 27.1%, 13.3%, 12.2%, and 11.5%, respectively, in those between 18 and 44 years old, and 15.9%, 12.2%, 8.0%, and 7.4% of those 45 and older, respectively. This was greater than the prevalence of these mental disorders in people with no chronic condition, where the prevalence is 3.5% in the younger, and 1.1% in the older group. However, the risk of these mental disorders is higher in older people. Thus, in those with gastrointestinal diseases when compared to people of the same age without any chronic condition the prevalence is 14.9 times higher, but for the same disease in the younger group it is 7.8. Conclusions: These findings link chronic conditions with a higher prevalence of mental disorders, which in the present study also highlights the greater comorbidity of mood and anxiety disorders in the elderly.

Problemas mentales, trastornos del afecto y de ansiedad en la población desplazada por la violencia en Colombia, resultados de la Encuesta Nacional de Salud Mental 2015 / Mental Problems, Mood and Anxiety Disorders in The Population Displaced by Violence in Colombia; Results of The National Mental Health Survey 2015

Resumen Introducción: Colombia tiene una gran población expuesta a la violencia, con una cifra importante de desplazados por esta, quienes se encuentran en mayor riesgo de vulnerabilidad, por lo que es necesario evaluar en ellos problemas y trastornos mentales para definir intervenciones específicas necesarias. Objetivos: Determinar la prevalencia de problemas y trastornos mentales de la población colombiana desplazada por el conflicto armado interno. Métodos: Datos emanados de la Encuesta Nacional de Salud Mental 2015. Se realizó la entrevista diagnóstica internacional compuesta (CIDI-CAPI) y el Cuestionario de Síntomas (SRQ) como indicador de posible enfermedad psiquiátrica; el consumo de alcohol se evaluó con el test de identificación de trastornos por consumo de alcohol (AUDIT); se diseñó una encuesta basada en la Prueba de Detección de Consumo de Alcohol, Tabaco y Sustancias (ASSIST); se modificó la Lista de Chequeo de Estrés Postraumático (PCL-C) para determinar posible estrés postraumático y se aplicó el Índice Multidimensional de Pobreza (IPM) y el APGAR familiar a los datos generales del individuo y del hogar. Resultados: Se detectó a 943 personas desplazadas por la violencia. Se presenta SQR positivo en el 16,4% (intervalo de confianza del 95% [IC95%], 13,2%-20,1%); la prevalencia de cualquiera de los trastornos mentales medidos (CIDI-CAPI) alguna vez en la vida es del 15,9% (IC95%, 11,9%-21,1%); la de ideación suicida es del 12,5% (IC95%, 9,0%-17,1%); la de consumo de alcohol excesivo, del 10,1% (IC95%, 7,2%-13,9%); el 35,6% (IC95%, 30,7%-40,8%) de las personas reportan que han vivido o presenciado o les han contado que alguien cercano ha tenido un evento traumático relacionado con el conflicto armado; se reporta un mayor riesgo de estrés postraumático en personas desplazadas que han reportado por lo menos un evento traumático (3,6%; IC95%, 2,2%-5,9%); la disfunción familiar en desplazados es ausente (74,8%; IC95%, 70,4%-78,8%). Conclusiones: La población desplazada tiene una alta prevalencia de problemas y trastornos mentales, lo que ratifica la situación de desventaja en que se encuentran

Abstract Introduction: Colombia has a large population exposed to violence. Our data suggest a significant number displaced by the conflict. As there is an increased risk of vulnerability, their problems and mental disorders need to be assessed in order to determine specific treatments. Objectives: To determine the prevalence of problems and mental disorders in those internally displaced by the conflict. Methods: Data was obtained from the National Mental Health Survey 2015. The diagnostic tools used were the composite international diagnosis interview (CIDI-CAPI), Self-reporting questionnaire (SQR). Alcohol consumption was assessed with the Alcohol Use Disorders Identification test (AUDIT). A survey based on the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) was developed. The modified Post-traumatic Stress Disorder (PTSD) Checklist-Civilian version (PCL-C) was used to determine possible post-traumatic stress Disorder. Multidimensional poverty index (MPI) and Family-Apgar questionnairewere applied to general individual and household data. Results: A total of 943 persons displaced by the conflict were reported, with self-report of symptoms in 16.4 (95% CI, 13.2-20.1). The prevalence of any of the measured mental disorders (CIDI-CAPI) ever in life was 15.9% (95% CI, 11.9-21.1), with a suicidal ideation of 12.5% (95%CI, 9.0-17.1), and excessive alcohol consumption in 10.1% (95% CI, 7.2-13.9). More than one-third (35.6%, (95% CI, 30.7-40.8) of people report having experienced, witnessed, or been told that someone close had had a traumatic event related to the armed conflict. An increased risk of PTSD is reported by 3.6% (95% CI, 2.2-5.9) displaced people that had reported at least one traumatic event. Family dysfunction in the displaced population is absent (74.8% (95%.CI, 70.4-78.8). Conclusions: The displaced population has a high prevalence of problems and mental disorders, which confirms their disadvantaged situation.

Funcionamiento psicosocial en pacientes agudos y crónicos no psiquiátricos en régimen hospitalario: depresión, alexitimia y falta de asertividad / Psychosocial functioning in non-psychiatric acute and chronic inpatients: depression, alexithymia and lack of assertiveness

Background: Depression, alexithymia, and lack of assertiveness interfere with individual psychosocial functioning and may result in longer hospitalization stay and poorer therapeutic results. Aim: To analyze the psychosocial functioning in acute and chronic patients and its association with psychological, clinical and sociodemographic variables. Material and Methods: We performed a cross-sectional study that included 80 inpatients of both sexes with organic pathology, aged between 18 to 70 years old, without any current psychiatric disorder. Clinical and sociodemographic data were collected from a semi-structured interview and hospital records. Beck Depression Inventory-IA, Toronto Alexithymia Scale-20 and Rathus Assertiveness Scale were administered. Results: Fifty five percent of patients had some degree of depression, 33% alexithymia and 34% lack of assertiveness. The levels of depression, alexithymia and lack of assertiveness in chronic patients were significantly higher than those observed in acute patients. Women and participants older than 60 years exhibited the highest degrees of depression. Alexithymia and lack of assertiveness were associated with a lower educational level. A negative significant correlation between alexithymia and assertiveness scores was observed among acute patients. Conclusions: Participants with chronic diseases had a lower psychosocial functioning. Less educated patients showed more alexithymic and less assertive features. We emphasized the need of a better management of these aspects by the health team, since social functioning might interfere with the outcome of physical illnesses.

Alcohol use disorders and psychiatric diseases in Colombia / Desórdenes y enfermedad psiquiátrica causada por el uso de alcohol en Colombia

Background: An accurate understanding of co-occurrence and comorbidity of alcohol use disorders (AUD) in Colombia is crucial for public health. Objective: A secondary analysis was conducted, using a 2003/2004 government´s population database to determine the lifetime associations between AUD and other mental and addictive disorders in people of Colombia aged 18-65 years. Methods: Several statistical analysis were performed: testing prevalence difference in mental disorders by whether the individual had an AUD; a stratified analysis by gender and logistic regression analyses accounting for differences in demographic, socio-economic, behavioral and self-reported health status variables. Results: People with AUD comprised 9% of the population, of which 88% were males and on average 37 years old. They were more likely to be males, be working, and be current smokers; and less likely to be at home or retired. The population with AUD had greater chance to comply with criteria for all disorders but minor depressive disorder, post-traumatic stress disorder, nicotine dependence, and oppositional defiant disorder. Conclusion:This study demonstrates a high prevalence of mental disorders in the adult population with AUD in Colombia. The findings highlight the importance of comorbidity as a sign of disease severity and impact on public health and supports the need for training of more professionals and developing appropriate interventions and services.

Antecedentes: Una comprensión precisa de la co-ocurrencia y la comorbilidad de los trastornos por consumo de alcohol (AUD) en Colombia es crucial para la salud pública. Objetivo: Se realizó un análisis secundario, utilizando una base de datos gubernamental de población 2003/2004 para determinar las asociaciones de vida entre los trastornos por consumo de alcohol y otros trastornos mentales y adictivos en personas de edades comprendidas entre 18 a 65 años de Colombia. Métodos: Varios análisis estadísticos se realizaron: pruebas de diferencia en la prevalencia de los trastornos mentales en función de si el individuo tenía un AUD; un análisis estratificado por sexo y análisis de regresión logística teniendo en cuenta las diferencias en las variables del estado de salud, demográficas, socioeconómicas, de comportamiento y de auto-reporte. Resultados: las personas con AUD fueron el 9% de la población, de los cuales 88% eran varones y en promedio tenían 37 años. Estas personas tenían trabajo y eran fumadores activos; y tenían menos probabilidad de estar en casa o ser jubilados. La población con AUD tenía mayores posibilidades de cumplir con los criterios de todos los trastornos, excepto el trastorno depresivo menor, el trastorno de estrés posttraumático, la dependencia a la nicotina, y el trastorno oposicional desafiante. Conclusión: Este estudio demuestra una alta prevalencia de trastornos mentales en la población adulta con trastornos por consumo de alcohol en Colombia. Los resultados destacan la importancia de la comorbilidad como un signo de gravedad de la enfermedad e impacto en la salud pública y apoyan la necesidad de formación de más profesionales y el desarrollo de intervenciones y servicios apropiados.

Association between duration of untreated bipolar disorder and clinical outcome: data from a Brazilian sample

Objective: Bipolar disorder (BD) is often left untreated for long periods, and this delay in treatment correlates with unfavorable prognosis. The present study sought to assess the magnitude of duration of untreated bipolar disorder (DUB) in Brazil. We hypothesized that DUB would be longer in Brazil than in developed countries, and would be associated with poor clinical outcomes. Methods: One hundred and fifty-two psychiatric outpatients were evaluated for BD diagnosis, demographics, DUB, and clinical outcomes. Results: The mean age and mean DUB were, respectively, 38.9±10.8 and 10.4±9.8 years. An extended DUB was associated with early onset of BD (p < 0.001), depression as first mood episode (p = 0.04), and presence of BD in a first-degree relative (p = 0.012). Additionally, a longer DUB was associated with poorer clinical outcomes, such as elevated rates of rapid cycling (p = 0.004) and anxiety disorders (p = 0.016), as well as lower levels of current full remission (p = 0.021). Conclusion: As DUB may be a modifiable variable, better medical education regarding mental health, more structured medical services, and population-wide psychoeducation might reduce the time between onset and proper management of BD, thus improving outcome.

Adherence to drug treatment regarding the users of psychosocial attention centers with mood disorders and schizophrenia / Adesão ao tratamento medicamentoso dos usuários de centros de atenção psicossocial com transtornos de humor e esquizofrenia / Adhesión al tratamiento medicamentoso de los usuarios de centros de atención psicosocial con trastornos de humor y esquizofrenia

The objective was to identify the prevalence and factors associated with non-adherence to psychiatric medication among users of Psychosocial Attention Centers. Dealing with a cross-sectional study, sheltering a prospective cohort of 563 users of Psychosocial Attention Centers in Pelotas. Household interviews were conducted and two questionnaires were applied. The prevalence of lack of accession was 32%, without significant differences according to gender, income, time of illness, diagnosis and type of medicine. Young individuals with higher education, with a partner, less frequent at the Psychosocial Attention Centers and with adverse effects, were least adherent to treatment. The lack of adhesion of the participants is mainly related to the adverse effects. Health policies need to focus on addressing this issue, proposing new strategies of adherence to treatments.

Objetivou-se identificar a prevalência e fatores associados à não adesão a medicamentos psicofármacos entre usuários dos Centros de Atenção Psicossocial. Trata-se de estudo transversal, aninhado a uma coorte prospectiva com 563 usuários dos Centros de Atenção Psicossocial de Pelotas. Foram realizadas entrevistas domiciliares e aplicados dois questionários. A prevalência da falta de adesão foi de 32%, sem diferença significativa de acordo com gênero, renda, tempo de doença, diagnóstico e tipo de medicamento. Indivíduos jovens, com maior escolaridade, com companheiro, com menor frequência aos Centros de Atenção Psicossocial e com efeitos adversos, foram menos aderentes ao tratamento. A falta de adesão dos participantes está principalmente relacionada aos efeitos adversos. As políticas de saúde precisam dedicar-se ao enfrentamento desse problema, propondo novas estratégias de adesão aos tratamentos.

La finalidad fue identificar la prevalencia y factores asociados a la no adhesión a medicamentos psicofármacos entre usuarios de los Centros de Atención Psicosocial. Se trata de estudio trasversal, anidado a una cohorte prospectiva con 563 usuarios de los Centros de Atención Psicosocial de Pelotas. Fueron desarrolladas entrevistas domiciliares y aplicados dos cuestionarios. La prevalencia de la falta de adhesión fue del 32%, sin diferencia significativa según el género, renta, tiempo de enfermedad, diagnóstico y tipo de medicamento. Individuos jóvenes, con mayor escolaridad, con compañero, con menor frecuencia a los Centros de Atención Psicosocial y con efectos adversos fueron menos adherentes al tratamiento. La falta de adhesión de los participantes está principalmente relacionada a los efectos adversos. Las políticas de salud necesitan dedicarse al enfrentamiento de ese problema, proponiendo nuevas estrategias de adhesión a los tratamientos.

Association of interleukin-10 levels with age of onset and duration of illness in patients with major depressive disorder

Objective: To investigate peripheral levels of interleukin-10 (IL-10) in patients with major depressive disorder (MDD) and bipolar disorder (BD) and evaluate the relationship between IL-10, age of disease onset, and duration of illness. Methods: Case-control study nested in a population-based cohort of 231 individuals (age 18-24 years) living in Pelotas, state of Rio Grande do Sul, Brazil. Participants were screened for psychopathology using the Mini-International Neuropsychiatric Interview (MINI) and the Structured Clinical Interview for DSM-IV (SCID-I). Serum IL-10 was measured using commercially available immunoassay kits. Results: Peripheral levels of IL-10 were not significantly different in individuals with MDD or BD as compared to controls. However, higher IL-10 levels were found in MDD patients with a later disease onset as compared with controls or early-onset patients. In addition, IL-10 levels correlated negatively with illness duration in the MDD group. In the BD group, age of onset and duration of illness did not correlate with IL-10 levels. Conclusion: Higher levels of IL-10 are correlated with late onset of MDD symptoms. Moreover, levels of this cytokine might decrease with disease progression, suggesting that an anti-inflammatory balance may be involved in the onset of depressive symptoms and disease progression in susceptible individuals.

Pharmacological treatment and staging in bipolar disorder: evidence from clinical practice

Objectives: Staging models for medical diseases are widely used to guide treatment and prognosis. Bipolar disorder (BD) is a chronic condition and it is among the most disabling disorders in medicine. The staging model proposed by Kapczinski in 2009 presents four progressive clinical stages of BD. Our aim was to evaluate pharmacological maintenance treatment across these stages in patients with BD. Methods: One hundred and twenty-nine subjects who met DSM-IV criteria for BD were recruited from the Bipolar Disorders Program at Hospital de Clínicas de Porto Alegre, Brazil. All patients were in remission. The subjects were classified according to the staging model: 31 subjects were classified as stage I, 44 as stage II, 31 as stage III, and 23 as stage IV. Results: Patterns of pharmacological treatment differed among the four stages (p = 0.001). Monotherapy was more frequent in stage I, and two-drug combinations in stage II. Patients at stages III and IV needed three or more medications or clozapine. Impairment in functional status (Functioning Assessment Short Test [FAST] scale scores) correlated positively with the number of medications prescribed. Conclusions: This study demonstrated differences in pharmacological treatment in patients with stable BD depending on disease stage. Treatment response can change with progression of BD. Clinical guidelines could consider the staging model to guide treatment effectiveness. .

Avaliação de desfechos perinatais/infantis em partos de pacientes com transtornos mentais maiores de um hospital psiquiátrico do Rio de Janeiro, Brasil / Adverse perinatal and infant outcomes among children born to mothers with major mental disorders in a psychiatric hospital in Rio de Janeiro, Brazil / Evaluación de los resultados perinatales/nacimientos infantiles en los pacientes con trastornos mentales en un hospital psiquiátrico de Río de Janeiro, Brasil

Desfechos perinatais/infantis constituem as principais causas de morbi-mortalidade infantil em países em desenvolvimento como o Brasil. Dentre os fatores de risco, está a presença de transtornos mentais maternos. Foi realizado um estudo longitudinal retrospectivo baseado no seguimento passivo por meio do método de linkage probabilístico para verificar a prevalência de desfechos perinatais/infantis em pacientes internadas em um hospital psiquiátrico público do Rio de Janeiro, Brasil, que tiveram partos durante o período de 1999 a 2009. As prevalências encontradas foram: baixo peso ao nascer (27,6%), prematuridade (17,4%), malformações (2,5%), óbitos fetais (4,8%) e neonatais (3,7%), sendo fatores associados o cuidado pré-natal insatisfatório, a presença de esquizofrenia e a baixa renda familiar. Os resultados reforçam que a prevalência de desfechos perinatais/infantis é elevada em mães com transtornos mentais maiores, sendo fundamental o rastreamento de sintomas psiquiátricos e o acompanhamento especializado por profissionais da saúde mental durante a assistência pré e pós-parto.

Adverse perinatal and infant outcomes are the leading causes of infant morbidity and mortality in developing countries like Brazil. Among the risk factors are maternal mental disorders. A retrospective longitudinal study was conducted based on passive follow-up using probabilistic record linkage to estimate the prevalence of adverse perinatal and infant outcomes in children of women admitted to a public psychiatric hospital in Rio de Janeiro, Brazil, and who gave birth from 1999 to 2009. Prevalence rates were: low birth weight (27.6%), prematurity (17.4%), malformations (2.5%), stillbirths (4.8%), and neonatal deaths (3.7%). Associated factors were deficient prenatal care, schizophrenia, and low income. The results corroborate the high prevalence of adverse perinatal and infant outcomes in mothers with major mental disorders, and that screening of psychiatric symptoms and specialized care by mental health professionals are essential throughout prenatal and postpartum care.

Los resultados perinatales/nacimientos infantiles son las principales causas de morbilidad y mortalidad en los países en desarrollo como Brasil. Entre los factores de riesgo está la presencia de trastornos mentales maternos. Se realizó un estudio longitudinal retrospectivo con seguimiento pasivo, por método de muestreo probabilístico, para estimar la prevalencia de resultados perinatales/nacimientos infantiles en pacientes ingresados en un hospital psiquiátrico público en Río de Janeiro, Brasil, donde se habían producido nacimientos durante el período de 1999 a 2009. Las tasas de prevalencia fueron: peso bajo al nacer (27,6%), prematuridad (17,4%), malformaciones (2,5%), muertes fetales (4,8%) y muertes neonatales (3,7%), los factores asociados son la atención prenatal deficiente, la presencia de esquizofrenia y bajos ingresos. Los resultados apoyan la prevalencia de efectos adversos en los resultados perinatales/nacimientos infantiles y es elevada en madres con trastornos mentales graves, siendo fundamental detección de síntomas psiquiátricos y asistencia especializada por profesionales de la salud mental durante la asistencia pre- y post-parto.

Comorbid psychiatric disorders and stages of change in cannabis-dependent, treatment-seeking patients

Objectives: To determine whether and to what extent cannabis dependence is associated with comorbid psychiatric disorders and specific stages of change in treatment-seeking patients. Methods: We evaluated 80 cannabis-dependent, treatment-seeking patients residing in an urban area. Data on cannabis dependence, psychiatric disorders, and motivation were obtained using the Schedules for Clinical Assessment in Neuropsychiatry and the University of Rhode Island Change Assessment (URICA). Results: A diagnosis of schizophrenia was found to correlate with lower motivation scores (p = 0.038), which could have a negative effect on adherence to treatment. Conclusion: The high prevalence of concurrent psychiatric disorders in cannabis-dependent patients should serve as a stimulus for early screening and treatment of such disorders. Health care professionals should be aware of the magnitude of this association to increase the level of motivation in cannabis-dependent patients with severe concurrent psychiatric disorders. .