Prevalence of cognitive impairment in HIV patients: vertical and horizontal transmission.

Antiretroviral treatment has significantly increased the survival of patients infected with HIV-1. However, with increased survival, cognitive changes associated with HIV are frequently observed in this population. The clinical manifestations of HIV changes can vary as a result of several aspects, including the virus transmission route. Several studies have pointed out premature neurological changes in vertically infected patients, while the manifestation of cognitive damage in adults may take a longer time. Objective: The aim of this study was to verify the prevalence of cognitive changes in patients with HIV via vertical transmission after the highly active antiretroviral therapy and the cognitive performance of these patients compared to a group of sexually infected patients. Methods: A total of 48 patients were evaluated, 25 with vertical transmission and 23 with sexual transmission, between May 2013 and February 2015 at the Institute of infectology Emilio Ribas. Neuropsychological tests were applied to assess cognitive performance, scales to assess symptoms of anxiety and depression, and sociodemographic questionnaire. Results: The results demonstrate that the frequency of cognitive impairment in vertically transmitted patients was higher than in sexually transmitted patients. Conclusions: These findings suggest that the deleterious effects of the HIV virus on the development of the central nervous system reverberate more strongly than in patients who acquire it after adulthood.

O tratamento antirretroviral tem aumentado significativamente a sobrevida de pacientes contaminados pelo HIV-1. Entretanto, com o aumento da sobrevida, observam-se frequentemente alterações cognitivas associadas ao HIV nessa população. As manifestações clínicas das alterações do HIV podem variar em decorrência de diversos aspectos, entre eles a via de transmissão do vírus. Diversos estudos têm apontado alterações neurológicas prematuras em pacientes contaminados por via vertical, enquanto a manifestação de danos cognitivos em adultos pode levar um tempo maior. Objetivo: O objetivo deste estudo foi verificar a prevalência das alterações cognitivas em pacientes com HIV via transmissão vertical após a era da terapia antirretroviral altamente ativa e o desempenho cognitivo desses pacientes comparado ao de um grupo de pacientes contaminados por via sexual. Métodos: Foram avaliados 48 pacientes, sendo 25 com transmissão vertical e 23 com transmissão sexual no período entre maio de 2013 e fevereiro de 2015, no Instituto de Infectologia Emílio Ribas. Foram aplicados testes neuropsicológicos para avaliar o desempenho cognitivo, escalas para avaliar sintomas de ansiedade e depressão e questionário sociodemográfico. Resultados: Os resultados demonstraram que a frequência de comprometimento cognitivo em pacientes contaminados via transmissão vertical foi maior do que naqueles contaminados via transmissão sexual. Conclusões: Essas descobertas sugerem que os efeitos deletérios do vírus HIV na formação do sistema nervoso central repercutem de forma mais acentuada do que em pacientes que o adquiriram após a vida adulta.

Cognitive assessment in patients with Hepatitis C submitted to treatment with Sofosbuvir and Simeprevir or Daclatasvir.

BACKGROUND: Hepatitis C can be defined as an infectious disease that develops an inflammatory activity, which may cause an impairment in the central nervous system, may cause cognitive impairments and symptoms of depression. OBJECTIVE: The objective of this study was to verify the cognitive performance of patients with chronic hepatitis C before and after treatment with simeprevir, sofosbuvir, and daclatasvir. METHODS: A prospective study was carried out in three stages: before, right after treatment, and six months after. Fifty-eight patients under clinical follow-up were evaluated at the Emílio Ribas Infectology Institute, in São Paulo, Brazil. The following instruments were used: sociodemographic questionnaire, Lawton's Scale, Beck's Depression Inventory, and a battery of neuropsychological tests that evaluated: intellectual function, memory, attention, executive function, and motor and processing speed). For statistical analysis, the analyses described (mean, frequency, and standard deviation), chi-square, and ANOVA were used. RESULTS: Most of the participants were male (n=30, 51.7%), with a mean of 58.23±8.79 years, mean schooling of 9.75±4.43 years. Comparing the results of neuropsychological evaluations (before, just after completion of drugs, and six months), a significant improvement was observed in relation to the acquisition of new knowledge (p=0.03), late visual memory (p=0.01), and tendency towards alternate attention (p=0.07). CONCLUSION: The treatment of the hepatitis C virus improved cognitive performance, especially in relation to memory.

[Spountaneous and induced abortion: anxiety, depression and guilty]. / Abortamento espontâneo e provocado: ansiedade, depressão e culpa.

BACKGROUND: Pregnancy has a symbolic meaning for each woman. It varies according to personality structure and is related to women's previous life experiences. OBJECTIVES: the aim was to characterize the women that suffered abortion, asking about anxiety and depression, looking for guilty feelings after abortion, and to compare results between women who suffered spontaneous abortion and those who had intentional abortion. METHODS: fifty women with spontaneous and fifty with induced abortion were interviewed 30 days after the procedure. A semistructured questionnaire with open and closed-end questions and Hospital Anxiety and Depression Scale were administered. RESULTS: woman who induced abortion revealed to be more anxious (mean 11) and depressed (mean 8.3) than woman with spontaneous abortion (means 8.7 and 6.1 respectively, p<0.05). CONCLUSIONS: women who presented induced abortion were more anxious and depressed, as shown by later life events, full of problematic feelings and the need for psychological support.

Cognitive assessment in patients with Hepatitis C submitted to treatment with Sofosbuvir and Simeprevir or Daclatasvir

BACKGROUND: Hepatitis C can be defined as an infectious disease that develops an inflammatory activity, which may cause an impairment in the central nervous system, may cause cognitive impairments and symptoms of depression. OBJECTIVE: The objective of this study was to verify the cognitive performance of patients with chronic hepatitis C before and after treatment with simeprevir, sofosbuvir, and daclatasvir. METHODS: A prospective study was carried out in three stages: before, right after treatment, and six months after. Fifty-eight patients under clinical follow-up were evaluated at the Emílio Ribas Infectology Institute, in São Paulo, Brazil. The following instruments were used: sociodemographic questionnaire, Lawton's Scale, Beck's Depression Inventory, and a battery of neuropsychological tests that evaluated: intellectual function, memory, attention, executive function, and motor and processing speed). For statistical analysis, the analyses described (mean, frequency, and standard deviation), chi-square, and ANOVA were used. RESULTS: Most of the participants were male (n=30, 51.7%), with a mean of 58.23±8.79 years, mean schooling of 9.75±4.43 years. Comparing the results of neuropsychological evaluations (before, just after completion of drugs, and six months), a significant improvement was observed in relation to the acquisition of new knowledge (p=0.03), late visual memory (p=0.01), and tendency towards alternate attention (p=0.07). CONCLUSION: The treatment of the hepatitis C virus improved cognitive performance, especially in relation to memory

INTRODUÇÃO: A hepatite C pode ser definida como uma doença infecciosa, que se desenvolve por uma atividade inflamatória, que pode gerar um comprometimento no Sistema Nervoso Central, podendo ocasionar prejuízos cognitivos e sintomas de depressão. OBJETIVO: O objetivo deste estudo foi verificar o desempenho cognitivo de pacientes com hepatite C crônica antes e após o tratamento com simeprevir, sofosbuvir e daclatasvir. MÉTODOS: Foi realizado um estudo prospectivo em três etapas: antes, logo após o tratamento e seis meses depois. Foram avaliados 58 pacientes em acompanhamento clínico no Instituto de Infectologia Emílio Ribas, em São Paulo, Brasil. Foram utilizados os seguintes instrumentos: questionário sociodemográfico, Escala de Lawton, Inventário de Depressão de Beck e uma bateria de testes neuropsicológicos que avaliaram: função intelectual, memória, atenção, função executiva e velocidade motora e de processamento). Para análise estatística, foram utilizadas as análises descritas (média, frequência e desvio padrão), qui-quadrado e ANOVA. RESULTADOS: A maioria dos participantes era do sexo masculino (n=30, 51,7%), com média de 58,23±8,79 anos, escolaridade média de 9,75±4,43 anos. Comparando os resultados das avaliações neuropsicológicas (antes, logo após a finalização dos medicamentos e seis meses), observou-se melhora significativa em relação à aquisição de novos conhecimentos (p=0,03), memória visual tardia (p=0,01) e tendência em relação a atenção alternada (p=0,07). CONCLUSÃO: O tratamento do vírus da hepatite C melhorou o desempenho cognitivo, principalmente em relação à memória

Psychogenic non-epileptic seizures and psychoanalytical treatment: results.

BACKGROUND: the occurrence of psychogenic non-epileptic seizures (PNES) is estimated to be between 2 to 33 cases in every 100,000 inhabitants. The number of patients with PNES reaches 19% of those treated as epileptics. Patients with PNES are treated as if they had intractable epilepsy, with unsatisfactory results even after medication treatment is used to its maximum. The aim of this study is to present the effects of individual psychoanalytical treatment in patients with PNES, assessing its impact in the evolution of the clinical picture and its association with sex, time of disease, social, psychological and professional harm, as well as going through with treatment. METHODS: The case base was composed of 37 patients with PNES. The diagnosis was reached with video-EEG monitoring. Psychoanalytical treatment was carried out through 12 months of weekly sessions timed for around 50-minutes each, in a total of 48 individual sessions. RESULTS: This study found a high rate of success in the treatment of PNES patients. 29.7% (n=11) of patients had cessation or cure of symptoms and 51.4% (n=19) had a decrease in the number of episodes. There is an association between cessation or decrease in the number of episodes and sex (p<0.01), religion (p<0.01) and concluding treatment (p<0.01). CONCLUSION: Individual psychoanalytical treatment applied to patients with PNES is considered effective and can be an essential form of assistance for the reduction or cessation of episodes.

[Abortion in women living in the outskirts of São Paulo: experience and socioeconomic aspects]. / Aborto provocado em mulheres da periferia da cidade de São Paulo: vivência e aspectos socioeconômicos.

PURPOSE: To compare and analyze socioeconomic aspects and the emotional experience of women with spontaneous or induced abortion and in women living in the outskirts of São Paulo. METHODS: A prospective case-control study carried out from July 2008 to March 2010, involving semi-structured interviews with women who presented a previous diagnosis of abortion and who had been admitted to two public hospitals in the outskirts of São Paulo. The study included 100 women with diagnosis of abortion and were hospitalized for curettage. Eleven women who reported induced abortion (11%) represented the case group. The control group (n=22) was selected at a 2:1 ratio according to the following procedure: for every case of induced abortion, the next two cases of spontaneous abortion at the same hospital. A semistructured interview was conducted with questions regarding emotional aspects and family, social and economic context. RESULTS: The women with induced abortion compared to the group with spontaneous abortion had lower educational level, with more frequent elementary level (82 versus 36%, p=0.04), lower income (median, R$ 1,000.00 versus R$ 1,400.00, p=0.04), lower personal income (median, R$ 200.00 versus R$ 333.00, p=0.04), higher frequency of negative feelings upon suspicion (82 versus 22%, p=0.004) and confirmation (72 versus 22%, p=0.03) of pregnancy. CONCLUSION: Among women looking for health care in hospitals in the outskirts of São Paulo, induced abortion is related to unfavorable socioeconomic conditions, which affects the emotional experiences of suspicion and confirmation of pregnancy.

Neuropsychological Assessment of 412 HIV-Infected Individuals in Sao Paulo, Brazil

HIV-associated neurocognitive disorders (HAND) remain frequent even among individuals receiving combined antiretroviral therapy (cART). In addition, HAND may adversely affect the quality of life and adherence to cART. There is scarce epidemiological information about HAND in Latin America. This cross-sectional study recruited HIV-infected patients from a tertiary teaching institution in São Paulo, Brazil, between May 2013 and February 2015. The patients were adults with at least 4 years of education and patients with current neurological or psychiatric diseases were excluded. HAND remain frequent even among individuals receiving cART, use of psychoactive substance, or inability to understand the content for neuropsychological evaluation. We used standardized tools to evaluate depression, use of psychoactive substances, and daily life activities, and we performed a comprehensive neuropsychological examination. HAND was classified using the Frascati criteria. Prevalence of HAND was estimated, and an associated variable of symptomatic HAND was identified by logistic regression. Four-hundred twelve HIV-infected patients were included [male: 281 (68%), mean age of 45.3 years]. Most of them [n = 340 (83.7%)] had an undetectable viral load. The prevalence of HAND was 73.6% (n = 303): 210 (50.9%) had asymptomatic neurocognitive involvement (ANI), 67 (16.2%) had mild neurocognitive disorder (MND), and 26 (6.3%) had HIV-associated dementia (HAD). The univariate logistic regression analysis showed that female gender, age older than 50 years, <11 years of schooling, CD4 count below 200 cells/mm3, presence of previous illnesses (e.g., diabetes, hypertension), opportunistic disease history, and a Beck Depression Inventory (BDI) score between 13 and 19 points were factors associated with symptomatic HAND (MND and HAD). However, a BDI score between 13 and 19 points was the single independent variable associated with symptomatic HAND. HAND was highly prevalent in São Paulo, Brazil, and ANI was the more frequent category of HAND. However, 22.5% of participants had symptomatic HAND. This finding constitutes a challenge in clinical practice. A BDI score between 13 and 19 points was the single independent variable associated with symptomatic HAND

Auditory hallucinations in tinnitus patients: Emotional relationships and depression.

INTRODUCTION: Over the last few years, our Tinnitus Research Group has identified an increasing number of patients with tinnitus who also complained of repeated perception of complex sounds, such as music and voices. Such hallucinatory phenomena motivated us to study their possible relation to the patients' psyches. AIMS: To assess whether hallucinatory phenomena were related to the patients' psychosis and/or depression, and clarify their content and function in the patients' psyches. METHOD: Ten subjects (8 women; mean age = 65.7 years) were selected by otolaryngologists and evaluated by the same psychologists through semi-structured interviews, the Hamilton Depression Rating Scale, and psychoanalysis interviews. RESULTS: We found no association between auditory hallucinations and psychosis; instead, this phenomenon was associated with depressive aspects. The patients' discourse revealed that hallucinatory phenomena played unconscious roles in their emotional life. In all cases, there was a remarkable and strong tendency to recall/repeat unpleasant facts/situations, which tended to exacerbate the distress caused by the tinnitus and hallucinatory phenomena and worsen depressive aspects. CONCLUSIONS: There is an important relationship between tinnitus, hallucinatory phenomena, and depression based on persistent recall of facts/situations leading to psychic distress. The knowledge of such findings represents a further step towards the need to adapt the treatment of this particular subgroup of tinnitus patients through interdisciplinary teamwork. Prospective.

Prevalence of depression and anxiety disorders in hospitalized patients at the dermatology clinical ward of a university hospital.

BACKGROUND: The objective of this study was to estimate the prevalence of depression and anxiety disorders in hospitalized patients at the dermatology ward at a university hospital in São Paulo, Brazil. OBJECTIVE: To assess the prevalence of mood and anxiety disorders in hospitalized patients at the dermatology ward at a university hospital in São Paulo. METHOD: A total of 75 patients, men and women, aged between 18 and 76 years, took part in the research. The study employed a descriptive, cross sectional and correlational method. The data was collected by means of a social demographic questionnaire and the PRIME-MD. RESULTS: It was found that 45.3 percent of the subjects presented with depressive symptoms, and 52 percent presented with symptoms of anxiety and that this survey showed moderate and high significant correlations (p<0,01; r= 0,616) for depression and anxiety. CONCLUSION: These facts could evidence the relationship between physical and psyche, just as the literature presents.

Impact of sociodemographic variables on executive functions / Impacto das variáveis sociodemográficas nas funções executivas

ABSTRACT Executive functions (EFs) regulate human behavior and allow individuals to interact and act in the world. EFs are sensitive to sociodemographic variables such as age, which promotes their decline, and to others that can exert a neuroprotective effect. Objective: To assess the predictive role of education, occupation and family income on decline in executive functions among a sample with a wide age range. Methods: A total of 925 participants aged 18-89 years with 1-28 years' education were submitted to assessment of executive functions using the Card Sorting Test (CST), Phonemic Verbal Fluency (FAS) Task and Semantic Verbal Fluency (SVF) Task. Data on income, occupation and educational level were collected for the sample. The data were analyzed using Linear Regression, as well as Pearson's and Spearman's Correlation. Results: Age showed a significant negative correlation (p<0.001) with performance on the CST, FAS and SVF, whereas education, income and occupation were positively associated (p<0.001) with the tasks applied. After application of the multivariate linear regression model, a significant positive relationship with the FAS was maintained only for education (p<0.001) and income (p<0.001). The negative relationship of age (p<0.001) and positive relationship of both education (p<0.001) and income (p<0.001 and p=0.003) were evident on the CST and SVF. Conclusion: Educational level and income positively influenced participants' results on executive function tests, attenuating expected decline for age. However, no relationship was found between occupation and the cognitive variables investigated.

RESUMO Funções executivas regulam o comportamento humano e permitem ao indivíduo interagir e agir no mundo. Elas são sensíveis a variáveis sociodemográficas como a idade, que promove seu declínio, e a outras que podem ter ação neuroprotetora. Objetivo: Avaliar o papel preditivo da escolaridade, atividade ocupacional e renda familiar sobre o declínio das funções executivas em uma amostra de ampla variação de idade. Métodos: 925 participantes saudáveis com idades de 18 a 89 anos e escolaridade de 1 a 28 anos foram submetidos ao exame de funções executivas com uma Tarefa de Classificação de Cartas (TCC) e de Fluência Verbal nominal (FVN) e semântica (FVS). Foram obtidas a renda, atividade ocupacional e escolaridade da amostra. Os dados foram analisados com Regressão Linear, Correlação Pearson e Spearman. Resultados: Idade apresentou correlação significativa (p<0,001) negativa com o desempenho em TCC, FVN e FVS, enquanto educação, renda e ocupação se relacionaram de forma positiva (p<0,001) com as tarefas utilizadas. Após modelo de regressão linear multivariada, apenas educação (p<0,001)e renda (p<0,001) mantiveram relação significativa positiva com FVN. A relação negativa da idade (p<0,001) e positiva de educação (p<0,001) e renda (p<0,001 e p=0,003) foi evidente em TCC e FVS. Conclusão: Escolaridade e renda influenciaram positivamente os resultados dos participantes nos testes de função executiva, tendo um efeito contrário ao declínio esperado para a idade. Por outro lado a ocupação não manteve relação com as variáveis cognitivas.

Risk of suicide in high risk pregnancy: an exploratory study.

OBJECTIVE: To identify the risk of suicidal behavior in high-risk pregnant women at a public hospital in São Paulo. METHODS: We conducted a semi-structured interview with each of the participants (n = 268) through a previously prepared questionnaire. Risk of suicidal behavior was assessed by the Portuguese version of PRIME-MD. RESULTS: The mean age of patients was 29 years (SD = 0.507) and gestation period was 30 weeks (SD = 0.556). Of the total sample, specific risk of suicide was found in 5% (n = 14). Of these, 85% have a stable relationship (married or cohabitating), the pregnancy was planned in 50% of cases, and 71% have no religion or professional activities. The correlation of risk of suicide with data from marital status, planned birth, age, education, professional practice, risk of prematurity, and religion showed that having a religion is statistically significant (p = 0.012). There were no positive associations for any of the other selected variables when compared with the risk of suicide. By correlating the risk of suicide with other characteristic symptoms of major depression, there was statistical significance in the sample with regard to insomnia or hypersomnia (p = 0.003), fatigue or loss of energy (p = 0.001), decreased or increased appetite (p = 0.005), less interest in daily activities (p = 0.000), depressed mood (p = 0.000), feelings of worthlessness or guilt (p = 0.000), decreased concentration (p = 0.002), and agitation or psychomotor retardation (p = 0.002). CONCLUSION: We found that religion can be a protective factor against suicidal behavior. Besides providing a social support network needed by women during pregnancy, religion supports belief in life after death and in a loving God, giving purpose to life and self esteem and providing models for coping with crises. The results show the importance of prevention and early diagnosis of suicidal behavior, since suicide is an attempt to move from one sphere to another by force, seeking to solve what seems impossible.

The association of major depressive episode and personality traits in patients with fibromyalgia.

INTRODUCTION: Personality traits have been associated with primary depression. However, it is not known whether this association takes place in the case of depression comorbid with fibromyalgia. OBJECTIVE: The authors investigated the association between a current major depressive episode and temperament traits (e.g., harm avoidance). METHOD: A sample of 69 adult female patients with fibromyalgia was assessed with the Temperament and Character Inventory. Psychiatric diagnoses were assessed with the Mini-International Neuropsychiatric Interview severity of depressive symptomatology with the Beck Depression Inventory, and anxiety symptomatology with the IDATE-state and pain intensity with a visual analog scale. RESULTS: A current major depressive episode was diagnosed in 28 (40.5%) of the patients. They presented higher levels of harm avoidance and lower levels of cooperativeness and self-directedness compared with non-depressed patients, which is consistent with the Temperament and Character Inventory profile of subjects with primary depression. However, in contrast to previous results in primary depression, no association between a major depressive episode and self-transcendence was found. CONCLUSIONS: The results highlight specific features of depression in fibromyalgia subjects and may prove important for enhancing the diagnosis and prognosis of depression in fibromyalgia patients.

Depression, stress and guilt are linked to the risk of suicide associated to ectopic pregnancy / Depressão, estresse e culpa ligam-se ao risco de suicídio associado à gestação ectópica

OBJECTIVE: To identify the risk for suicidal behavior in women who had a fetal loss resulting from ectopic pregnancy and verify the association of suicide risk with depression and psychosocial aspects. METHODS: Thirty-one women diagnosed with an ectopic pregnancy were interviewed. Major depression was identified using the Primary Care Evaluation of Mental Disorders questionnaire. The Prenatal Psychosocial Profile questionnaire was used to measure stress, social support and self-esteem. RESULTS: We found that 16% (n = 5) reported suicide risk behavior. The correlation between suicide risk and symptoms of major depression, stress and guilt was statistically significant. CONCLUSIONS: Depression and stress have been linked to the presence of suicide risk, further increasing the vulnerability of women with ectopic prgnancy, which generates intense emotional reactions as guilt.

OBJETIVO: identificar o risco de comportamento suicida em mulheres que apresentaram perda fetal resultante de gestação ectópica e verificar a associação entre risco suicida com depressão e aspectos psicológicos. MÉTODO: Trinta e uma mulheres diagnosticadas com gestação ectópica foram entrevistadas. Diagnóstico de Depressão maior foi identificado através do questionário Primary Care Evaluation of Mental Disorders. O questionário Prenatal Psychosocial Profile foi utilizado para avaliação de estresse, suporte social e auto-estima. RESULTADOS: Foi encontrado índice de 16% (n = 5) de mulheres que reportaram risco de comportamento suicida. A correlação entre risco suicida e sintomas de depressão maior, estresse e culpa foi estatisticamente significante. CONCLUSÃO: Depressão e estresse estiveram relacionados com a presença de risco suicida, aumentando a vulnerabilidade das mulheres com gestação ectópica, o que gera reações emocionais intensas como a culpa.

Depression, emotional and social aspects in the abortion context: a comparison between two Brazilian capitals.

OBJECTIVE: To assess emotional and social aspects in the experience of abortion and the diagnosis of major depression, comparing women from two Brazilian cities (São Paulo--SP, Natal--RN). METHODS: A transversal study was carried out from January 2009 to May 2010, through semi-directed interviews with women undergoing an abortion (up to 22 weeks gestation) treated at university hospitals in São Paulo--SP (n = 166) and Natal--RN (n = 150). The Portuguese version of the Primary Care Evaluation of Mental Disorders (PRIME-MD) instrument was applied for the diagnosis of depression. RESULTS: There was no significant difference (p = 0.223) in the proportion of induced abortions when comparing the two capital cities: Natal (7.3%) and São Paulo (12.0%). The diagnosis of depression was high among women undergoing an abortion and was significantly higher in Natal than in São Paulo (50.7% vs. 32.5%, p < 0.01). Regarding emotional aspects, there was no difference in the occurrence of guilt feelings (Natal 27.7%; São Paulo 23.3%; p = 0.447). The partner's involvement was considered satisfactory by women in similar proportions in the two capitals (Natal 62.0%; São Paulo 59.0%, p = 0.576). No difference was found in the proportion of women who reported violence, related or not to the abortion (Natal 22.9%; São Paulo 16.6%; p = 0.378). CONCLUSION: Although there was no difference between the emotional and social aspects in the comparison between the two capitals, there was a high proportion of women with major depression, more frequent in the city of Natal than in São Paulo, which demonstrates the importance of psychosocial support in the women's healthcare system.

Depression during pregnancy in women with a medical disorder: risk factors and perinatal outcomes.

BACKGROUND: Approximately one-fifth of women present depression during pregnancy and puerperium, and almost 13% of pregnant women experience a major depressive disorder. OBJECTIVE: The aim of this study was to identify risk factors for depression among pregnant women with a medical disorder and to evaluate the influence of depression on perinatal outcomes. METHODS: Three hundred and twenty-six pregnant women with a medical disorder were interviewed. A semistructured interview was conducted for each participant using a questionnaire that had been developed previously. Major depression was diagnosed using the Portuguese version of the Primary Care Evaluation of Mental Disorders (PRIME-MD). The medical records of the participants were thoroughly reviewed to evaluate the perinatal results. RESULTS: Major depressive disorder was diagnosed in 29 cases (9.0%). The prevalence of major depression was as follows: 7.1% for preeclampsia or chronic hypertension, 12.1% for cardiac disorder, 7.1% for diabetes mellitus, 6.3% for maternal anemia, 8.3% for collagenosis and 12.5% for a high risk of premature delivery. An univariate analysis showed a significant positive correlation between an average household income below minimum wage and a PRIME-MD diagnosis of major depression. A multiple regression analysis identified unplanned pregnancy as an independent predictor of major depression (86.2% in the group with a diagnosis of major depression by PRIME-MD vs. 68.4% in the group without major depression). A comparison between women who presented major depression and those who did not revealed no significant differences in the perinatal results (i.e., preterm delivery, birth weight and low Apgar scores). CONCLUSION: In the present study, unplanned pregnancy in women with a medical disorder was identified as a risk factor for major depression during gestation. Major depression during pregnancy in women with a medical disorder should be routinely investigated using specific methods.

Velocidade de processamento da informação em adolescentes de escolas públicas e privadas / Speed of Information processing in adolescents from public and private schools / Velocidad de Tratamiento de la información en los adolescentes de escuelas públicas y privadas

A velocidade de processamento da informação se refere à atividade mental por certo período de tempo. O objetivo do estudo foi investigar esta velocidade de processamento em adolescentes de 14 anos de escolas públicas e privadas. Foram selecionadas 14 adolescentes (sexo feminino) que cursavam o 9º ano do Ensino Fundamental ou o 1º ano do Ensino Médio. Foram avaliadas por meio do IVP (Código, Procurar símbolos e Cancelamento) da WISC-IV e do Teste de Trilhas Coloridas Infantil (TTCI). O teste qui-quadrado apontou maior número de quase erros no TTCI em meninas que frequentavam escola privada. Nenhuma diferença foi encontrada entre os grupos no IVP. Embora o tipo de escola não pareça produzir diferenças entre os grupos no IVP, o número de quase erros, indicativo de distração, mostrou-se mais sensível para identificar essas diferenças. Sugere-se que o número de quase erros possa indicar diferenças mais sutis entre os grupos.(AU)

The speed of information processing refers to attainment of mental activity in a certain period of time. The aim of this study was investigate the speed of information processing in 14 years old girls, who attended public and private schools. We selected 14 girls who were in the 9th grade of elementary school or 1st year of high school. Half of them attended public school and the other half attended private school. They were evaluated by: Processing Speed Index - PSI (Coding, Symbol Search and Cancellation) of the WISC - IV and the Trail Making Test Colored Children (TTCI). The chi-square test showed a higher number of near-misses in CCTT in girls attending private school compared to girls attending public school. No difference was found between the two groups in the PSI. Although the type of school does not seem to produce significant differences between the groups in the PVI, the number of nearmisses showed a more sensitive measure to identify these differences. It is suggested that the number of near-misses may indicate subtle differences between groups.(AU)

La velocidad de procesamiento de información se refiere a la realización de actividad mental en un determinado período de tiempo. El objetivo de este estudio fue investigar la velocidad de procesamiento de información en adolescentes de 14 años que asisten a escuelas públicas y privadas. Fueron seleccionado 14 adolescentes, de sexo femenino que curzaban 9 º o 10º grado. La mitad asistia a la escuela pública y la otra mitad a la escuela privada. Fueron evaluadas utilizando las siguientes pruebas: IVP (Código, búsqueda y cancelación de símbolos) de la bacteria WISC-IV y test infantil de sequencias coloreadas (TISC). El t-test mostro un mayor número de casi errores en TISC en las niñas que asisten a las escuelas privadas. No se encontraron diferencias entre los dos grupos en las otro pruebas. Se sugiere que la medición de la cantidad de casi errores revelan una mayor sensibilidad en TTCI.(AU)

Velocidade de processamento da informação em adolescentes de escolas públicas e privadas / Speed of Information processing in adolescents from public and private schools / Velocidad de Tratamiento de la información en los adolescentes de escuelas públicas y privadas

A velocidade de processamento da informação se refere à atividade mental por certo período de tempo. O objetivo do estudo foi investigar esta velocidade de processamento em adolescentes de 14 anos de escolas públicas e privadas. Foram selecionadas 14 adolescentes (sexo feminino) que cursavam o 9º ano do Ensino Fundamental ou o 1º ano do Ensino Médio. Foram avaliadas por meio do IVP (Código, Procurar símbolos e Cancelamento) da WISC-IV e do Teste de Trilhas Coloridas Infantil (TTCI). O teste qui-quadrado apontou maior número de quase erros no TTCI em meninas que frequentavam escola privada. Nenhuma diferença foi encontrada entre os grupos no IVP. Embora o tipo de escola não pareça produzir diferenças entre os grupos no IVP, o número de quase erros, indicativo de distração, mostrou-se mais sensível para identificar essas diferenças. Sugere-se que o número de quase erros possa indicar diferenças mais sutis entre os grupos...

The speed of information processing refers to attainment of mental activity in a certain period of time. The aim of this study was investigate the speed of information processing in 14 years old girls, who attended public and private schools. We selected 14 girls who were in the 9th grade of elementary school or 1st year of high school. Half of them attended public school and the other half attended private school. They were evaluated by: Processing Speed Index - PSI (Coding, Symbol Search and Cancellation) of the WISC - IV and the Trail Making Test Colored Children (TTCI). The chi-square test showed a higher number of near-misses in CCTT in girls attending private school compared to girls attending public school. No difference was found between the two groups in the PSI. Although the type of school does not seem to produce significant differences between the groups in the PVI, the number of nearmisses showed a more sensitive measure to identify these differences. It is suggested that the number of near-misses may indicate subtle differences between groups...

La velocidad de procesamiento de información se refiere a la realización de actividad mental en un determinado período de tiempo. El objetivo de este estudio fue investigar la velocidad de procesamiento de información en adolescentes de 14 años que asisten a escuelas públicas y privadas. Fueron seleccionado 14 adolescentes, de sexo femenino que curzaban 9 º o 10º grado. La mitad asistia a la escuela pública y la otra mitad a la escuela privada. Fueron evaluadas utilizando las siguientes pruebas: IVP (Código, búsqueda y cancelación de símbolos) de la bacteria WISC-IV y test infantil de sequencias coloreadas (TISC). El t-test mostro un mayor número de casi errores en TISC en las niñas que asisten a las escuelas privadas. No se encontraron diferencias entre los dos grupos en las otro pruebas. Se sugiere que la medición de la cantidad de casi errores revelan una mayor sensibilidad en TTCI...

Psychogenic non-epileptic seizures and psychoanalytical treatment: results / Crises não epilépticas psicogênicas e tratamento psicanalítico: resultados.

Background: the occurrence of psychogenic non-epileptic seizures (PNES) is estimated to be between 2 to 33 cases in every 100,000 inhabitants. The number of patients with PNES reaches 19% of those treated as epileptics. Patients with PNES are treated as if they had intractable epilepsy, with unsatisfactory results even after medication treatment is used to its maximum. The aim of this study is to present the effects of individual psychoanalytical treatment in patients with PNES, assessing its impact in the evolution of the clinical picture and its association with sex, time of disease, social, psychological and professional harm, as well as going through with treatment. Methods: The case base was composed of 37 patients with PNES. The diagnosis was reached with video-EEG monitoring. Psychoanalytical treatment was carried out through 12 months of weekly sessions timed for around 50-minutes each, in a total of 48 individual sessions. Results: This study found a high rate of success in the treatment of PNES patients. 29.7% (n=11) of patients had cessation or cure of symptoms and 51.4% (n=19) had a decrease in the number of episodes. There is an association between cessation or decrease in the number of episodes and sex (p<0.01), religion (p<0.01) and concluding treatment (p<0.01). Conclusion: Individual psychoanalytical treatment applied to patients with PNES is considered effective and can be an essential form of assistance for the reduction or cessation of episodes. .

Introdução: estima-se que o número de casos de pacientes com crises não epilépticas psicogênicas (CNEP) seja de 2 a 33 por 100 mil habitantes. O índice de CNEP corresponde ainda a, aproximadamente, 19% dos pacientes tratados como epilépticos. Os pacientes com CNEP são tratados como portadores de epilepsia refratária, chegando ao limite máximo do tratamento medicamentoso e sem a obtenção de resultados satisfatórios. Objetivo: relatar os efeitos do tratamento psicanalítico individual em pacientes com CNEP de forma a avaliar a evolução do quadro clínico de CNEP e verificar sua associação com gênero, tempo de crise, prejuízos sociais, afetivos e profissionais, bem como término do tratamento. Métodos: a casuística foi composta por 37 pacientes com diagnóstico de CNEP feito por meio da monitoração por vídeo-EEG. Foram realizadas sessões de tratamento psicanalítico: atendimento clínico individual com frequência semanal, com duração aproximada de 50 minutos e duração total de 48 sessões em 12 meses. Resultados: este estudo constatou elevado índice de sucesso no tratamento dos pacientes com CNEP: 29,7% (n = 11) de cessação/cura dos sintomas e 51,4% (n = 19) de redução das crises convulsivas. Foi constatada associação entre cessar ou reduzir as crises e gênero (p<0,01), religião (p<0,01) e término do tratamento (p<0,01). Conclusão: este estudo apontou eficácia do tratamento psicanalítico individual realizado com pacientes com CNEP, podendo ser considerada uma forma de assistência essencial para que haja decréscimo ou cessação das crises. .

Evento traumático, fibromialgia e complicações na saúde: um estudo de caso / Traumatic event, fibromyalgia and health complicationsa: a case study

Introdução: O presente artigo discorre sobre um caso clínico de uma paciente com os diagnósticos de fibromialgia e dor crônica, que procurou, voluntariamente, atendimento psicológico em um hospital de referência na cidade de São Paulo, para tratar de seu quadro doloroso e das consequências da história de abuso sexual ocorrido na infância. Objetivo: Assim, buscou-se investigar como um evento de vida traumático e mal elaborado pode implicar numa repetição de situações dolorosas, podendo estar associado à formação de sintomas corporais. Método: Foram realizadas dez entrevistas clínicas de orientação Psicanalítica, que duravam cerca de 50 minutos, durante um período de quatro meses. Resultados: As entrevistas foram um importante veículo para a exposição da angústia e conflitos da paciente, que associou os eventos de abuso sexual durante a infância ao surgimento e manutenção do quadro doloroso (fibromialgia e dor crônica). Além disso, observou-se a maneira como a paciente chegou até a analista, voluntariamente, o que apontou para um transbordamento de conteúdos que a estavam mobilizando naquele momento. Conclusões: Concluiu-se que o histórico de abuso sexual da paciente pôde gerar implicações na saúde e que ela ocupou durante a vida não somente o lugar de "abusada", mas também de "abusadora" de si mesma, nos momentos quando maltratou seu corpo, por meio da repetição de situações onde ela produziu, numa tentativa inconsciente de elaboração, satisfação pulsional. Foi também possível concluir que as entrevistas psicanalíticas, como método de investigação e tratamento psicanalítico, foram capazes de promover uma ressignificação do mundo interno da paciente e consequente mudança na posição subjetiva e na condição de saúde da mesma(AU)

Introduction: This article discusses a case of a patient with a diagnosis of fibromyalgia and chronic pain, which sought voluntarily psychological care in a referral hospital in the city of São Paulo, to treat their painful symptoms and consequences of history of sexual abuse in childhood. Objective: Thus, we sought to investigate as a traumatic life event and ill prepared can imply a repetition of painful situations, and may be associated with the formation of bodily symptoms. Method: Ten interviews were conducted clinics Psychoanalytic orientation, which lasted about 50 minutes over a period of four months. Results: The interviews were an important vehicle for the exposure of the patient's distress and conflict, which associated the events of sexual abuse during childhood to the emergence and maintenance of the pain (fibromyalgia and chronic pain). Furthermore, it was observed how the patient came to the analyst, voluntarily, which pointed to an overflow of content that were mobilizing at the time. Conclusions: We conclude that a history of sexual abuse of patients could generate implications for health and she held for life not only the place of "abused", but also "abuser" of herself at times when your body manhandled through the repetition of situations where she produced, in an unconscious attempt of elaboration, drive satisfaction. It was also possible to conclude that the psychoanalytic interviews as research method and psychoanalytic treatment were able to promote a redefinition of the internal world of the patient and the consequent change in subject position and the same health condition(AU)

Avaliação da velocidade de processamento em uma amostra de crianças de 7 a 10 anos com e sem hipótese diagnóstica de TDAH / Processing speed assessment in a sample of 7- 10 year-olds children

Comparamos o desempenho de crianças com hipótese diagnóstica de TDAH ao de crianças saudáveis nos testes de velocidade de processamento da Escala de Inteligência Wechsler para crianças, 4ª edição (WISC-IV). Foram selecionadas dezesseis crianças, sendo 8 com hipótese diagnóstica de TDAH (Grupo TDAH) e 8 saudáveis (Grupo controle), de ambos os sexos, com idade entre 7 a 10 anos, provenientes do ensino público da cidade de Itatiba/SP. A velocidade de processamento foi avaliada pelos seguintes testes: Código, Procurar Símbolos e Cancelamento. Os resultados mostraram que não houve diferença significativa entre os grupos. Concluímos que os resultados examinados por meio da escala SNAP-IV não apresentaram diferença estatística entre os grupos. Futuros estudos poderiam ampliar o número de participantes de modo a equilibrar o número de participantes por faixa etária(AU)

We compared the performance of children with diagnosis of ADHD to the healthy children on tests of the Wechsler Intelligence Scale for Children, 4th edition (WISC-IV) Processing Speed. We selected sixteen children, 8 with diagnosis of ADHD (ADHD group) and 8 healthy subjects (control group), of both sexes, aged 7-10 years, from the public schools of the city of Itatiba / SP. Processing speed was assessed by the following tests: Coding Browse Symbols and Cancellation. The results showed no significant difference between the groups we conclude that the results examined by SNAP-IV scale, no statistically significant difference between groups. Future studies could expand the number of participants in order to balance the number of participants of age(AU)