Preterm birth and postpartum depression within 6 months after childbirth in a Brazilian cohort.

Preterm birth (PTB) and postpartum depression (PPD) are important public health issues, and although literature mainly supports the association between them, some reviews have highlighted methodological limitations in the studies in this field, restricting the interpretation of such finding. This study aimed at assessing the association between PTB and PPD, by comparing groups of preterm and full-term mothers in two Brazilian cities with contrasting sociodemographic indicators. This prospective convenience cohort study assessed 1421 women during pregnancy, at childbirth, and in the postpartum period. The Edinburgh Postnatal Depression Scale (EPDS) was administrated to assess PPD within 6 months after delivery and women were considered probably depressed if scores were EDPS ≥ 12. PTB was defined as the delivery before 37 completed weeks of pregnancy. A multivariate Poisson regression was used to estimate relative risk for PPD in mothers of preterm infants, and the final analysis models were adjusted for psychosocial variables, selected according to the directed acyclic graph (DAG) approach. Frequencies of PPD were not significantly different in mothers of preterm and full-term infants, in neither city. In the final adjusted model, PTB was not associated with PPD. The association between PTB and PPD was not confirmed in two large samples from two Brazilian cities with contrasting socioeconomic profile. However, maternal health during pregnancy plays an important role in predicting PPD. Prenatal care should promote maternal mental health as an effort towards decreasing unfavored outcomes for mothers, infants, and families.

Postpartum depression screening by telephone: a good alternative for public health and research.

This study verified the reliability and validity of the Edinburg Postpartum Depression Scale (EPDS) administered by telephone interviews. In a cross-sectional study of a cohort from Brazil (BRISA), the EPDS was administered by telephone to 1,083 women within 12 months postpartum, and 257 (23.7 %) participants had an EPDS score ≥10. At 67 ± 48 days after their telephone interview, 199 (EPDS ≥10 = 96; EPDS <10 = 103) participants were interviewed face-to-face using the Structured Clinical Interview for DSM-IV (SCID) and completed the EPDS again by self-report. In 90 participants, the diagnosis of major depressive episode was confirmed by the SCID (EPDS ≥10 = 65; EPDS <10 = 25). The Cronbach's alpha coefficient was 0.861. The Spearman's correlation between the EPDS administered by telephone and the self-reported EPDS was 0.69 (p < 0.001). The receiver-operating characteristic (ROC) curve for the EPDS administered by telephone was 0.78 (95 % confidence interval (CI) = 0.72 to 0.84). Scores ≥10 showed a sensitivity of 72.2 %, a specificity of 71.6 %, and a positive predictive value of 67.7 %. The application of the EPDS by telephone is a suitable alternative for clinical practice and research and represents a method to optimize the diagnosis of postpartum depression.

Comparison of major depression diagnostic classification probability using the SCID, CIDI, and MINI diagnostic interviews among women in pregnancy or postpartum: An individual participant data meta-analysis.

OBJECTIVES: A previous individual participant data meta-analysis (IPDMA) identified differences in major depression classification rates between different diagnostic interviews, controlling for depressive symptoms on the basis of the Patient Health Questionnaire-9. We aimed to determine whether similar results would be seen in a different population, using studies that administered the Edinburgh Postnatal Depression Scale (EPDS) in pregnancy or postpartum. METHODS: Data accrued for an EPDS diagnostic accuracy IPDMA were analysed. Binomial generalised linear mixed models were fit to compare depression classification odds for the Mini International Neuropsychiatric Interview (MINI), Composite International Diagnostic Interview (CIDI), and Structured Clinical Interview for DSM (SCID), controlling for EPDS scores and participant characteristics. RESULTS: Among fully structured interviews, the MINI (15 studies, 2,532 participants, 342 major depression cases) classified depression more often than the CIDI (3 studies, 2,948 participants, 194 major depression cases; adjusted odds ratio [aOR] = 3.72, 95% confidence interval [CI] [1.21, 11.43]). Compared with the semistructured SCID (28 studies, 7,403 participants, 1,027 major depression cases), odds with the CIDI (interaction aOR = 0.88, 95% CI [0.85, 0.92]) and MINI (interaction aOR = 0.95, 95% CI [0.92, 0.99]) increased less as EPDS scores increased. CONCLUSION: Different interviews may not classify major depression equivalently.

Correlations between changes in the hypothalamic-pituitary-adrenal axis and neurochemistry of the anterior cingulate gyrus in postpartum depression.

BACKGROUND: This study aimed to investigate associations between indicators of hypothalamic-pituitary-adrenal axis (HPA) functioning and metabolite levels in the anterior cingulate gyrus (ACG) of women with postpartum depression (PPD). METHODS: The sample (mean age = 28.5 ±â€¯4.6 years) consisted of 20 women with PPD and 19 postpartum euthymic (PPE) women. Brain metabolites were quantified by proton magnetic resonance spectroscopy (1H-MRS). Salivary cortisol samples were collected upon awakening and 30 min and 12 h later, at 20.6 ±â€¯6.6 (PPD) and 23.0 ±â€¯7.4 (PPE) weeks after childbirth. RESULTS: There were no significant differences between groups in respect to metabolite levels in the ACG. Compared with PPE, PPD women had less diurnal variation (DVr%). In the PPD group, positive correlations were found between DVr% and myo-inositol (mI/Cr) levels, and between cortisol awakening response (CARi%) and glutamate + glutamine (Glx/Cr) levels. The correlation between CARi% and Glx/Cr remained significant even after controlling for the interval, in weeks, from birth and MR spectroscopy and to hormonal data collection, and the use of contraceptives. LIMITATIONS: The limitations of the study include the small sample size and the use of oral contraceptives by around half of the sample. CONCLUSIONS: In the remote postpartum period (mean 21.8 ±â€¯6.9 weeks) and in the presence of depressive episodes, the decreased responsiveness of the HPA axis after awakening and a smaller decrease in cortisol levels over the day were associated with lower levels of metabolites in the ACG. These results may contribute to the development of biological models to explain the etiology of PPD.

Perceived Stress Scale: confirmatory factor analysis of the PSS14 and PSS10 versions in two samples of pregnant women from the BRISA cohort.

This study aimed to assess the dimensional structure, reliability, convergent validity, discriminant validity, and scalability of the Perceived Stress Scale (PSS). The sample consisted of 1,447 pregnant women in São Luís (Maranhão State) and 1,400 in Ribeirão Preto (São Paulo State), Brazil. The 14 and 10-item versions of the scale were assessed using confirmatory factor analysis, using weighted least squares means and variance (WLSMV). In both cities, the two-factor models (positive factors, measuring resilience to stressful situations, and negative factors, measuring stressful situations) showed better fit than the single-factor models. The two-factor models for the complete (PSS14) and reduced scale (PSS10) showed good internal consistency (Cronbach's alpha ≥ 0.70). All the factor loadings were ≥ 0.50, except for items 8 and 12 of the negative dimension and item 13 of the positive dimension. The correlations between both dimensions of stress and psychological violence showed the expected magnitude (0.46-0.59), providing evidence of an adequate convergent construct validity. The correlations between the scales' positive and negative dimensions were around 0.74-0.78, less than 0.85, which suggests adequate discriminant validity. Extracted mean variance and scalability were slightly higher for PSS10 than for PSS14. The results were consistent in both cities. In conclusion, the single-factor solution is not recommended for assessing stress in pregnant women. The reduced, 10-item two-factor scale appears to be more appropriate for measuring perceived stress in pregnant women.

Saúde mental em concursos de residência médica: implicações das Diretrizes Nacionais Curriculares de 2014 / Mental health in medical residency admission tests: implications of the 2014 National Curriculum Guidelines

Resumo: Introdução: Devido à importância da saúde mental (SM) na prática médica, as Diretrizes Curriculares Nacionais do Curso de Graduação em Medicina (DCN) de 2014 estabeleceram a valorização desse tema. Embora as provas de residência médica (RM) devam ser influenciadas por essa diretriz, desconhecia-se se elas estavam de acordo com as mudanças. Objetivo: Este trabalho teve como objetivo avaliar se as diretrizes determinadas pelo Ministério da Saúde têm sido seguidas, buscando a devida valorização do tema SM. Método: Realizou-se uma pesquisa documental, sobre como a SM vem sendo abordada nos concursos de RM, na modalidade acesso direto, antes e depois da publicação das DCN. Para isso, selecionaram-se, por conveniência, nove instituições do Sul e Sudeste do Brasil, delimitando-se um período de dez anos para análise. Dois investigadores realizaram a seleção e análise das provas e das questões. Decisões em casos de discordância foram feitas a partir da avaliação de um terceiro investigador (juiz). Após esse processo, categorizaram-se as questões em subtemas, e tabularam-se os dados em uma planilha, analisada descritivamente com distribuições percentuais para variáveis qualitativas e medidas de tendência central. Resultado: Os conteúdos de SM corresponderam a 3,8% das provas. Não foi constatado crescimento na porcentagem de questões consequente à publicação das DCN. Verificou-se o predomínio das questões com essa temática nas áreas de clínica médica e de saúde coletiva (n = 129/n = 109), contrapondo-se à cirurgia geral (n = 0). Houve uma superioridade do subtema "psicofarmacologia" (n = 102). Conclusão: Como visto, no que tange à SM, as DCN não alcançaram ainda os concursos de RM. O enfoque da SM dado às questões das instituições analisadas permanece com uma visão biologicista.

Abstract: Introduction: Due to the importance of Mental Health (MH) in medical practice, the National Curriculum Guidelines for the Undergraduate Course in Medicine (DCN) published in 2014 established inclusion of this subject matter. Although medical residency tests must have been affected by this resolution, it remained unclear whether those tests were in line with the new guidelines. Objective: this study aims to assess whether the guidelines determined by the Ministry of Health are being followed and, thus, giving due appreciation of the theme of MH. Method: Documentary research was conducted on how MH has been approached in the "Direct Access" Medical Residency (RM) admission tests, before and after the publication of the DCN. For this purpose, nine institutions in the south and southeast of Brazil were selected for convenience, delimiting a 10-year period for analysis. The selection, analysis of the evidence and questions were developed by two researchers. In the event of disagreement, decisions were made based on the evaluation of a third investigator (judge). After this process, the questions were categorized into subtopics and the data tabulated on a spreadsheet, analyzed descriptively with percentage distributions for qualitative variables and measures of central tendency. Result: The MH content corresponded to 3.8% of the tests. There was no increase in the percentage of issues resulting from the publication of the DCNs. There was a predominance in the areas of Clinical Medicine and Public Health (n=129 / n=109), in contrast to "General Surgery" (n=0). Superiority of the subtopic "Psychopharmacology" was found (n=102). Conclusion: As described, there are not yet any implications of the DCN found in the MR admission tests in relation to MH. The way MH is approached in the test paper questions of the analyzed institutions continues to reflect a biological perspective.

Altered functioning of the HPA axis in depressed postpartum women.

BACKGROUND: The present study aimed to evaluate the relationship between the functioning of the hypothalamic-pituitary-adrenal (HPA) axis and major depressive episodes in the remote postpartum period. METHODS: The sample (mean age, 28.0±5.3 years) consisted of 37 depressed postpartum women (DPP), 42 euthymic postpartum women (EPP) and 25 non-postpartum healthy women (HC). Salivary cortisol samples were collected immediately after awakening and 30min, 3 and 12h later, at approximately the sixth month postpartum (mean, 169.6±60.3 days). RESULTS: Differences in cortisol levels were observed at awakening (DPPEPP=HC). The relative increment in the cortisol awakening response (CARi%) was significantly higher in HC (113.5±94.3) than in EPP (63.1±69.8) and DPP (32.2±49.6). The relative reduction in diurnal variation (DVr%) was lower in DPP (56.5±41.8) than in EPP (75.6±22.4) and HC (75.1±13.0). LIMITATIONS: The main limitation was cortisol collection on a single day and without measurement at midnight. CONCLUSIONS: Our findings suggest that the remote postpartum period involves attenuation of HPA axis reactivity; this dysregulation is more pronounced in the presence of DPP, which is associated with a reduction in cortisol diurnal variation. Abnormalities in the neuroendocrine system related to stress processing, present even several months after delivery, can represent vulnerability to mental disorders. Thus, improvements in the mental health care of postpartum women are needed.

The Influence of genetic factors on peripartum depression: A systematic review.

BACKGROUND: This systematic review aimed to explore the potential influence of genetic factors on the symptoms of peripartum depression and to critically analyze the methodologies employed by the examined studies. METHODS: A systematic review of the literature indexed prior to July 2014 identified 200 articles. After applying the inclusion and exclusion criteria, 39 papers were included. RESULTS: The papers predominantly featured a molecular genetic approach (n=35), and the majority examined polymorphisms (n=27). Most studies used samples of Caucasians living in high income countries. The results suggest that the influence of genetic factors become more consistent when methodological variations among the studies are considered. Environmental stressors are also important variables that influence the relationship between genetic factors and peripartum depressive states. In addition, differences in the influence of genetic factors were observed depending upon the precise time point during pregnancy or the postpartum period that was examined in the studies. The late stages of pregnancy and the early postpartum period were times of greater genetic vulnerability. LIMITATIONS: This study was limited by the small number of papers reviewed and by the lack of information regarding whether the effects of genetics on peripartum depression are specific to certain ethnicities and/or stressors. CONCLUSIONS: Genetic studies of perinatal depression reinforce a pathophysiological role of the hormonal changes inherent in the childbirth period. However, the distinction between depressive episodes that begin during pregnancy from those that begin during the postpartum period can still be useful to improve our understanding of the physiopathology of depressive disorders.

Implementation of a Mental Health internship in a higher education institution / A trajetória da implantação de um internato de Saúde Mental em uma instituição de ensino superior / Implantación de un internado médico en Salud Mental en una institución de educación superior

ABSTRACT The approval of the More Doctors Program has triggered a number of readjustments of the National Curricular Guidelines (DCNs) for Medical Education, like the creation of a mental health internship integrated into the health service and community. Due to this demand, the higher education institutions have been encouraged to innovate in their teaching-learning methodologies in order to guarantee a generalist, humanistic and critical professional education. We report the experience of a private higher education institution in the implementation of a mental health internship in consonance with the new DCNs. We present all the steps of the implementation, reporting the participation of students, supervisors, preceptors and managers. We show that a mental health internship linked to different levels of healthcare promotes learning conditions capable of favoring the decentralization of care and application of the community/family approach.

RESUMO A aprovação do Programa Mais Médicos (PMM) desencadeou uma série de readequações das Diretrizes Curriculares Nacionais (DCN) do ensino médico, como a inserção de um internato em Saúde Mental integrado ao serviço-comunidade. Frente a essa demanda, as instituições de ensino superior (IES) foram encorajadas a inovar em suas metodologias de ensino-aprendizagem, a fim de garantir uma formação profissional generalista, humanista e crítica. Assim, relatamos, neste artigo, a experiência de uma IES privada na implantação de um internato em Saúde Mental em consonância com as novas DCN. Apresentamos todas as etapas da implantação do internato, envolvendo a atuação de diversos atores desse processo, como estudantes, supervisores, preceptores e gestores. Mostramos que um estágio em Saúde Mental vinculado aos diferentes níveis de atenção à saúde promove condições de aprendizagem capazes de favorecer a descentralização do cuidado e a aplicação da abordagem comunitária/familiar.

RESUMEN La aprobación del Programa Más Médicos ha provocado una serie de ajustes a las Directrices Curriculares Brasileñas (DCB) como la inserción de un internado médico en Salud Mental integrado al servicio-comunidad. Frente a esta demanda, se alentó a las Instituciones de Educación Superior (IES) a innovar en sus metodologías de enseñanza-aprendizaje para garantizar una formación profesional generalista, humanista y crítica. Informamos en este artículo la experiencia de una IES privada en la implementación de un internado médico en salud mental en consonancia con la nueva DCB. Presentamos todas las etapas de la implantación del internado, relatando la participación de los estudiantes, supervisores, preceptores y gestores. Se muestra que un internado en salud mental vinculado a los diferentes niveles de atención a la salud promueve condiciones de aprendizaje capaces de favorecer la descentralización del cuidado y la aplicación del enfoque comunitario/familiar.

Violence and depressive symptoms during pregnancy in BRISA cohort: using structural equation modeling approach / Violência e sintomas de depressão na gestação e materna na coorte BRISA: uma abordagem com modelagem de equações estruturais

Abstract Objectives: to analyze associations among violence against pregnant women, depressive symptoms during pregnancy and maternal depression symptoms. Methods: a sample of 1,139 mothers was conducted on a prenatal cohort study in the municipality of São Luís in Brazil. Psychological and physical violence against pregnant women were measured by the World Health Organization Violence Against Woman. Depressive symptoms during pregnancy were measured by the Escala de Depressão do Centro de Estudos Epidemiológicos (CES-D) (Depression Scale for Epidemiological Studies Center) and maternal depression symptoms were measured by the Edinburgh Postnatal Depression Scale (EPDS). The conceptual model of the structural equation modeling contained socioeconomic situation, social support, psychological and physical violence and depression during pregnancy as determinants of the maternal depression symptoms. Results: maternal depression symptoms were more frequently reported by pregnant women who suffered psychological violence (Standardized Coefficient, SC=0.256; p-value, p<0.001), physical violence (SC=0.221 p<0.001) and those who presented depressive symptoms during pregnancy SC=0.322, p<0.001). Depressive symptoms during pregnancy mediated the effects on physical and psychological violence on maternal depression. Conclusions: pregnant women who were submitted to psychological and physical violence and presented depressive symptoms during pregnancy frequently reported more of having maternal depression symptoms.

Resumo Objetivos: analisar associações entre violência contra gestantes, sintomas de depressão na gestação e sintomas de depressão materna. Métodos: estudo em uma coorte de pré-natal no município de São Luís (Brasil) com amostra de 1.139 mães. Violência psicológica e violência física contra gestantes foram medidas pelo instrumento World Health Organization Violence against woman. Sintomas de depressão na gestação foram medidos pela Escala de Depressão do Centro de Estudos Epidemiológicos (CES-D) e sintomas de depressão materna foram medidos pela Escala de Depressão materna de Edimburgo (EPDS). O modelo conceitual, por modelagem de equações estruturais, teve situação socioeconômica, suporte social, violência psicológica, física e depressão na gestação como determinantes de sintomas de depressão materna. Resultados: Sintomas de depressão materna foram relatados por gestantes que mais frequentemente sofreram violência psicológica (Coeficiente Padronizado, CP=0.256; p-valor, p<0.001), violência física (CP=0.221 p<0.001) e apresentavam sintomas de depressão na gestação (CP=0.322 p<0.001). Sintomas de depressão na gestação mediaram efeitos das violências física e psicológica na depressão materna. Conclusões: gestantes submetidas à violência psicológica e física e que apresentaram sintomas de depressão na gestação relataram com mais frequência sintomas de depressão materna.

Antinuclear antibodies testing as a routine screening for systemic lupus erythematosus in patients presenting first-episode psychosis.

AIMS: This report discusses the use of antinuclear antibody (ANA) detection as a screening test for neuropsychiatry systemic lupus erythematosus (NPSLE) in patients presenting a first-episode psychosis. METHODS: We reviewed the medical records of 85 patients admitted to an emergency service due to first-episode psychosis, during a 1-year period, for whom ANA detection was performed through an IFI HEp2 cell assay. ANA-positive patients were subsequently evaluated for autoantibodies and neuroimaging exams. RESULTS: Three patients presented as ANA positive in the initial screening and further investigation confirmed NPSLE in two patients. The patients were treated with antipsychotics and cyclophosphamide pulses with satisfactory outcomes. CONCLUSION: Even though ANA detection is not specific, it is a low-cost procedure and could be an important screening test for NPSLE in the early-onset psychosis.

Perceived Stress Scale: confirmatory factor analysis of the PSS14 and PSS10 versions in two samples of pregnant women from the BRISA cohort / Escala de Estresse Percebido: análise fatorial confirmatória das versões EEP14 e EEP10 em duas amostras de gestantes da coorte BRISA / Escala de Estrés Percibido: análisis factorial confirmatorio de las versiones EEP14 y EEP10 en dos muestras de gestantes de la cohorte BRISA

This study aimed to assess the dimensional structure, reliability, convergent validity, discriminant validity, and scalability of the Perceived Stress Scale (PSS). The sample consisted of 1,447 pregnant women in São Luís (Maranhão State) and 1,400 in Ribeirão Preto (São Paulo State), Brazil. The 14 and 10-item versions of the scale were assessed using confirmatory factor analysis, using weighted least squares means and variance (WLSMV). In both cities, the two-factor models (positive factors, measuring resilience to stressful situations, and negative factors, measuring stressful situations) showed better fit than the single-factor models. The two-factor models for the complete (PSS14) and reduced scale (PSS10) showed good internal consistency (Cronbach's alpha ≥ 0.70). All the factor loadings were ≥ 0.50, except for items 8 and 12 of the negative dimension and item 13 of the positive dimension. The correlations between both dimensions of stress and psychological violence showed the expected magnitude (0.46-0.59), providing evidence of an adequate convergent construct validity. The correlations between the scales' positive and negative dimensions were around 0.74-0.78, less than 0.85, which suggests adequate discriminant validity. Extracted mean variance and scalability were slightly higher for PSS10 than for PSS14. The results were consistent in both cities. In conclusion, the single-factor solution is not recommended for assessing stress in pregnant women. The reduced, 10-item two-factor scale appears to be more appropriate for measuring perceived stress in pregnant women.

O objetivo deste estudo foi avaliar a estrutura dimensional, confiabilidade, validade convergente, validade discriminante e escalabilidade da Escala de Estresse Percebido (EEP). A amostra foi constituída por 1.447 gestantes de São Luís (Maranhão) e 1.400 de Ribeirão Preto (São Paulo), Brasil. Foram avaliadas as versões com 14 e 10 itens por meio da análise fatorial confirmatória, utilizando-se o estimador dos mínimos quadrados ponderados ajustados pela média e variância (WLSMV). Em ambas as cidades, os modelos bifatoriais (fatores positivo, medindo resiliência a situações estressoras, e negativo, medindo situações de estresse) apresentaram melhor ajuste do que os unifatoriais. Os modelos bifatoriais da escala completa (EEP14) e da reduzida (EEP10) apresentaram boa consistência interna (alfa de Cronbach ≥ 0.70). Todas as cargas fatoriais foram ≥ 0.50, exceto as dos itens 8 e 12 da dimensão negativa e a do item 13 da dimensão positiva. As correlações entre ambas as dimensões do estresse com a violência psicológica foram na magnitude esperada (0,46-0,59), fornecendo evidência de validade de construto convergente adequada. As correlações entre as dimensões positiva e negativa das escalas foram em torno de 0,74-0,78, menores do que < 0,85, o que sugere adequada validade discriminante. A variância média extraída e a escalabilidade foram ligeiramente maiores para a EEP10 do que a para a EEP14. Os resultados foram consistentes em ambas as cidades. Em conclusão, a solução unifatorial não é recomendada para avaliar estresse em mulheres grávidas. A escala bifatorial reduzida com 10 itens parece ser mais apropriada para medir estresse percebido em gestantes.

El objetivo de este estudio fue evaluar la estructura dimensional, confiabilidad, validez convergente, validez discriminante y escalabilidad de la Escala de Estrés Percibido (EEP). La muestra estaba constituida por 1.447 gestantes de Sao Luis (Maranhão) y 1.400 de Ribeirão Preto (São Paulo), Brasil. Se evaluaron las versiones con 14 y 10 ítems, mediante un análisis factorial confirmatorio, utilizándose el estimador de los mínimos cuadrados ponderados ajustados por la media y variancia (WLSMV). En ambas ciudades, los modelos bifactoriales (factores positivo, midiendo resiliencia a situaciones estresantes, y negativo, midiendo situaciones de estrés) presentaron un mejor ajuste que el de los unifactoriales. Los modelos bifactoriales de la escala completa (EEP14) y de la reducida (EEP10) presentaron una buena consistencia interna (alfa de Cronbach ≥ 0.70). Todas las cargas factoriales fueron ≥ 0.50, excepto las de los ítems 8 y 12 de la dimensión negativa y la del ítem 13 de la dimensión positiva. Las correlaciones entre ambas dimensiones del estrés con la violencia psicológica fueron en la magnitud esperada (0,46-0,59), proporcionando evidencia de validez del constructo convergente adecuada. Las correlaciones entre las dimensiones positiva y negativa de las escalas fueron en torno de 0,74-0,78, menores que < 0,85, lo que sugiere una adecuada validez discriminante. La variancia media extraída y la escalabilidad fueron ligeramente mayores para la EEP10 que para la EEP14. Los resultados fueron consistentes en ambas ciudades. En conclusión, la solución unifactorial no está recomendada para evaluar estrés en mujeres embarazadas. La escala bifactorial reducida con 10 ítems parece ser más apropiada para medir el estrés percibido en gestantes.

Contribuições dos manuais diagnósticos para a avaliação e o tratamento do transtorno desafiador-opositor na infância: a importância da topografia através de um estudo de caso / Contributions of diagnostic manuals for the assessment and treatmentof oppositional-defiant disorder in childhood: the importance oftopography through a case study

Tópico: A aproximação da Psiquiatria à Terapia Analítico-comportamental através da utilização do Manual Diagnóstico e Estatístico dos Transtornos Mentais 5ª edição (DSM-V). Objetivo: discorrer sobre a utilização de critérios diagnósticos à luz da teoria behaviorista. Tese sob análise: os princípios analítico-comportamentais orientam não focar apenas na topografia dos comportamentos. Os manuais diagnósticos e estatísticos focam apenas na topografia dos sintomas, utilizando uma abordagem não baseada em teoria específica. Apesar de aparentemente discrepantes, é possível aproximar conceitos da teoria comportamental com conceitos de nosologia psiquiátrica. Fontes usadas: bibliografia publicada e estudo de um caso clínico de uma criança de 9 anos com o diagnóstico de transtorno desafiador-opositor segundo o DSM-V. Conclusões: a utilização de manuais diagnósticos pode ser uma estratégia para o terapeuta que utiliza os princípios da Análise do Comportamento para nortear sua prática. Esta utilização pode ter impactos positivos na avaliação, na programação e na eficácia do tratamento.(AU)

Topic: The link of Psychiatry and the Analytical Behavioral Therapy using Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-V). Aim: explore the use of a diagnostic manual based on the behavioral theory. Thesis under analysis: behavior analytic principles recommend does not focus only on the topography of behaviors. The diagnostic and statistical manual focuses only on the topography of symptoms, using an approach not based on a specific theory. Although seemingly conflicting, it is possible to connect the concepts of behavioral theory to psychiatric nosology. Sources used: published literature and study of a clinical case of a 9 year old children diagnosed with oppositional-defiant disorder according to DSM-V. Conclusion: the use of diagnostic manuals can be a strategy for the therapist who uses the Behavior Analysis as a principle in his practice. This use can influence in the assessment, planning and treatment efficacy.(AU)

Contribuições dos manuais diagnósticos para a avaliação e o tratamento do transtorno desafiador-opositor na infância: a importância da topografia através de um estudo de caso / Contributions of diagnostic manuals for the assessment and treatment of oppositional-defiant disorder in childhood: the importance of topography through a case study

Tópico: a aproximação da Psiquiatria à Terapia Analítico-comportamental através da utilização do Manual Diagnóstico e Estatístico dos Transtornos Mentais 5ª edição (DSM-V). Objetivo: discorrer sobre a utilização de critérios diagnósticos à luz da teoria behaviorista. Tese sob análise: os princípios analítico-comportamentais orientam não focar apenas na topografia dos comportamentos. Os manuais diagnósticos e estatísticos focam apenas na topografia dos sintomas, utilizando uma abordagem não baseada em teoria específica. Apesar de aparentemente discrepantes, é possível aproximar conceitos da teoria comportamental com conceitos de nosologia psiquiátrica. Fontes usadas: bibliografia publicada e estudo de um caso clínico de uma criança de 9 anos com o diagnóstico de transtorno desafiador-opositor segundo o DSM-V. Conclusões: a utilização de manuais diagnósticos pode ser uma estratégia para o terapeuta que utiliza os princípios da Análise do Comportamento para nortear sua prática. Esta utilização pode ter impactos positivos na avaliação, na programação e na eficácia do tratamento.

Topic: the link of Psychiatry and the Analytical Behavioral Therapy using Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-V). Aim: explore the use of a diagnostic manual based on the behavioral theory. Thesis under analysis: behavior analytic principles recommend does not focus only on the topography of behaviors. The diagnostic and statistical manual focuses only on the topography of symptoms, using an approach not based on a specific theory. Although seemingly conflicting, it is possible to connect the concepts of behavioral theory to psychiatric nosology. Sources used: published literature and study of a clinical case of a 9 year old children diagnosed with oppositional-defiant disorder according to DSM-V. Conclusion: the use of diagnostic manuals can be a strategy for the therapist who uses the Behavior Analysis as a principle in his practice. This use can influence in the assessment, planning and treatment efficacy.

Nova curva da OMS 2006: implicações para o crescimento de recém-nascidos pré-termo em comparação com a curva do CDC 2000 / WHO 2006 child growth standards: implications for the preterm growth in comparison to the CDC 2000

Objetivos: Comparar a proporção de crianças com falha no crescimento aos 12 meses de idade, utilizando-se as referências do CDC 2000 e da OMS 2006. Material e Métodos: Estudo retrospectivo do tipo coorte de grupo único. A amostra de 194 recém-nascidos, constituída a partir do grupo de RNPT acompanhados no ACRIAR, nascidos consecutivamente no Hospital das Clínicas da Universidade Federal de Minas Gerais (HC/UFMG) durante o período de 1990-2003, com peso ao nascer menor que 1500g. O peso foi obtido do nascer até 12 meses de idade corrigida. Foi feita categorização das crianças, utilizando-se o percentil 5 das referências do CDC 2000 da OMS 2006. Para a avaliação da concordância entre as duas classificações, utilizou-se o índice Kappa (k). Resultados: A utilização da curva do CDC 2000 como referência mostra um maior número de crianças mal nutridas aos 12 meses, quando comparado a curva da OMS 2006. As duas curvas apresentam concordância moderada, entretanto quando se analisa as crianças abaixo do percentil 5, observa-se algumas discrepâncias. Conclusões: É necessário saber como usar a nova curva prescritiva da OMS 2006 e qual o impacto de seu uso na avaliação nutricional.

Objective: To compare the proportion of children with growth failure at 12 months of age using CDC’s 2000 and WHO’s 2006 references. Methods: Retrospective study of cohort group. A sample of 194 newborns with weight less than 1500g was accompanied during the period of 1990 at 2003. The data were collected from ACRIAR follow-up center. The weight was obtained from birth to 12 months of corrected age. The five (5%) percentile from the CDC 2000 and WHO 2006 were used as reference to categorize children. In order to estimate the agreement between these classifications the Kappa index (k) was used. Results: The curve of CDC 2000 reference shows a greater number of underweight children at 12 months when compared to the WHO 2006 curve. The two curves present moderate agreement, however when examining children below the percentile five there were some discrepancies. Conclusions: It is important to know how to use the new prescriptive curve of the WHO 2006 and the impact of its use in nutrition evaluating.