Case report on the multiple pathways to posttraumatic stress disorder following suicide.

Trauma pathology is not only a sum of risk factors, but emerges as a result of complex causal interaction. The case presented here illustrates the pathway from suicide exposure to the development of fully-fledged treatment-resistant posttraumatic stress disorder (PTSD), demonstrating how recognized risk factors can act in tandem to generate a difficult to treat syndrome. From a clinical perspective, bottom-up approaches that take into account real coping experiences of people bereaved by suicide are more effective to facilitate recovery and prevent adverse outcomes. Finally, even though treatment is often implemented, the diagnosis can be missed further complicating coping and treatment.

Socioeconomic and substance use changes in emerging adults and their relationship with mood disorders in a population-based cohort.

In this report, we aim to assess the interaction of bipolar disorder and major depressive disorder with the evolution of social roles, economic classification, and substance misuse in emerging adults. This is a longitudinal population-based study (n = 231 at baseline), in which participants were reassessed at a mean of 5 years after baseline. A structured clinical interview was used to diagnose the participants with bipolar disorder and major depression; a control group without mood disorders was included. Men with mood disorders were less likely to be married in the beginning of the study and less likely to work in the follow-up. Women with major depression were less likely to study and more likely to be in a lower economic class at the beginning of the study. In comparison, women with bipolar disorder were less likely to live with their parents and more likely to live with their children in the first wave of the study. Substance misuse was more likely in people with mood disorders, especially in men, and women with bipolar disorder had the highest likelihood in the follow-up. Albeit longitudinal analyses were limited by a possibly insufficient sample size and mediating mechanisms for change, such as stigma, were not explored, the study suggests sex-related specificities regarding the change in social roles and substance use in people with mood disorders. Emerging adults, especially those with mood disorders, are in a period of change and instability and at a greater risk for substance use and abuse.

Early illness progression in mood disorders: A population-based longitudinal study.

This study is aimed at assessing changes in functioning among young people from the general population with bipolar disorder and major depressive disorder over a period of five years. Specifically, we hypothesized that significant illness progression would take place during euthymia over time in bipolar disorder. We conducted a longitudinal study with 231 people, assessed at baseline and again at a five-year follow-up. A structured clinical interview was used to diagnose participants with mood disorders. A control group without mood disorders was also included. Functioning was assessed with the Functioning Assessment Short Test, and linear mixed models were used to analyze the effect of psychopathology on change in functioning. Mood disorders were associated with significant functional impairment, but functioning significantly improved in both groups over the 5-year follow-up period. Depressive episodes, however, were associated with worse functioning at follow-up, independently of depression severity. In contrast to our initial hypothesis, we found a worsening of functioning in a five-year period associated only with depressive episodes. This suggests that interventions focused on the prevention of mood episodes early in the course of illness may be particularly promising to reduce adverse functioning outcomes.

Clinical outcomes and childhood trauma in bipolar disorder: A community sample of young adults.

Childhood trauma is a complex experience, much reported by subjects with bipolar disorder. There are still few studies that assess its consequences in a community sample of bipolar in early stage. The aim of the present study is to assess the association between childhood trauma and clinical outcomes, including the global functioning, in a community sample of young adults with bipolar disorder. This is a cross-sectional study with a community sample of subjects with bipolar disorder, from 23 to 30 years old, with and without childhood trauma. The trauma experiences during childhood were assessed by Childhood Trauma Questionnaire (CTQ). The functioning was assessed by Functioning Assessment Short Test (FAST). Ninety subjects with bipolar disorder were included in the study (30 with childhood trauma and 60 without childhood trauma). Young adults with bipolar disorder and childhood trauma showed higher prevalence of current suicide risk, higher severity of depressive symptoms, and higher functioning impairment as compared to subjects with bipolar disorder without childhood trauma. The childhood trauma experiences appear to be an environmental risk factor for worse clinical outcomes and higher functional impairment.

[Work overload faced by caregivers assisting frequenters of a psychosocial care center for children and adolescents in the south of Brazil]. / Sobrecarga em cuidadores de usuários de um centro de atenção psicossocial infanto-juvenil no sul do Brasil.

The scope of this article is to compare the work overload averages among caregivers assisting frequenters of a Psychosocial Care Center for children and adolescents (CAPSi) in Pelotas-Brazil in relation to the mental health of the children and adolescents and the caregivers themselves. It involved a cross-sectional study conducted with the primary caregiver of CAPSi frequenters. The work overload was evaluated using the Zarit Burden Interview scale and the mental health problems of frequenters were assessed using the Strengths and Difficulties Questionnaire (SDQ). To verify the presence of common potential mental disorders of caregivers, a Self-Report Questionnaire (SRQ-20) was used. T-test and ANOVA was used for data analysis. The average work overload was significantly higher in caregivers of frequenters with behavioral problems (p = 0.000), hyperactivity (p = 0.001) and relationship problems with peers (p = 0.001). IT was also significantly higher among those classified as potential cases of common mental disorders (p = 0.000); women caregivers (p = 0.032) and those with past problems with the Judiciary and/or Guardianship Council involving a frequenter (p = 0.039). The importance of work geared to caregivers to enhance the quality of care and quality of life of the caregivers themselves should be highlighted.

Brief psychoeducation for bipolar disorder: impact on quality of life in young adults in a 6-month follow-up of a randomized controlled trial.

There are scarce follow-up studies evaluating the role of psychoeducation in the treatment of bipolar disorder, especially in a young sample, with a recent diagnosis and that probably received a few previous interventions. This was a randomized clinical trial with young adults aged 18-29 years, who had been diagnosed with bipolar disorder through the Structured Clinical Interview for DSM (SCID). The evaluation of quality of life was carried out using the Medical Outcomes Survey 36-Item Short-Form Health Survey (MOS SF-36). All participants were randomized into two groups: combined intervention (psychoeducation plus medication) and treatment-as-usual (medication). The sample consisted of 61 patients divided in two groups (29 usual treatment; 32 combined intervention). The quality of life domains did not reveal statistically significant differences when comparing baseline, post-intervention and 6-month follow-up evaluations, which indicates that there is no difference between combined intervention and usual intervention regarding quality of life improvement. Both groups presented improvements in quality of life domains, except General Health and Bodily Pain, at post-intervention. Moreover, this improvement persisted at 6-month follow-up, except for the Role Physical Health domain, which remained reduced. Combined Psychoeducation plus pharmacological intervention is so effective in improving quality of life perception as it is pharmacological only intervention.

Sobrecarga em cuidadores de usuários de um centro de atenção psicossocial infanto-juvenil no sul do Brasil / Work overload faced by caregivers assisting frequenters of a psychosocial care center for children and adolescents in the south of Brazil

O objetivo deste artigo é comparar as médias de sobrecarga de cuidadores de usuários do Centro de Atenção Psicossocial infanto-juvenil (CAPSi) da cidade de Pelotas (RS) em relação à saúde mental de crianças e adolescentes e a do próprio cuidador. Estudo transversal realizado com o principal cuidador do usuário do CAPSi. A sobrecarga foi avaliada pela escala Zarit Burden Interview e os problemas de saúde mental dos usuários através da Strengths and Difficulties Questionnaire (SDQ). Para verificar a presença de possíveis transtornos mentais comuns (TMC) nos cuidadores, utilizou-se o questionário Self-Report Questionnaire (SRQ-20). Foi utilizado o Teste t e ANOVA para análise dos dados. As médias de sobrecarga foram significativamente mais altas nos cuidadores de usuários com problemas de conduta (p = 0,000), hiperatividade (p = 0,001) e problemas de relacionamento com colegas (p = 0,001). Também foram significativamente maiores entre aqueles classificados como possíveis casos de TMC (p = 0,000); entre as mulheres (p = 0,032) e os que já tiveram problemas na Justiça e/ou Conselho Tutelar (p = 0,039) envolvendo o usuário. Salienta-se a importância de trabalhos destinados aos cuidadores visando melhorar a qualidade do cuidado e da vida dos mesmos.

The scope of this article is to compare the work overload averages among caregivers assisting frequenters of a Psychosocial Care Center for children and adolescents (CAPSi) in Pelotas-Brazil in relation to the mental health of the children and adolescents and the caregivers themselves. It involved a cross-sectional study conducted with the primary caregiver of CAPSi frequenters. The work overload was evaluated using the Zarit Burden Interview scale and the mental health problems of frequenters were assessed using the Strengths and Difficulties Questionnaire (SDQ). To verify the presence of common potential mental disorders of caregivers, a Self-Report Questionnaire (SRQ-20) was used. T-test and ANOVA was used for data analysis. The average work overload was significantly higher in caregivers of frequenters with behavioral problems (p = 0.000), hyperactivity (p = 0.001) and relationship problems with peers (p = 0.001). IT was also significantly higher among those classified as potential cases of common mental disorders (p = 0.000); women caregivers (p = 0.032) and those with past problems with the Judiciary and/or Guardianship Council involving a frequenter (p = 0.039). The importance of work geared to caregivers to enhance the quality of care and quality of life of the caregivers themselves should be highlighted.