Pattern evolution of antidepressants and benzodiazepines use in a cohort

OBJECTIVE: In recent decades there has been an increase in the use of antidepressants (AD) and a decrease in the use of benzodiazepines (BDZ). Prevalence, cumulative incidence, and factors associated with the incidence of AD and BDZ use in a Brazilian population were estimated in this article. METHODS: Data were collected with a self-administered questionnaire in a cohort of employees from a university in Rio de Janeiro. The prevalence of the use of AD and BDZ was calculated for 1999 (4,030), 2001 (3,574), 2006-07 (3,058), and 2012 (2,933). The cumulative incidences of the use of AD and BDZ between 1999 and 2007 were estimated by the Poisson models with robust variance estimates. RESULTS: In 1999, the prevalence of the use of AD and BDZ were 1.4% (95%CI: 1.1–1.8) and 4.7% (95%CI: 4.1–5.4), respectively; in 2012, they were 5.4% (95%CI: 5.5–6.2) and 6.8% (95%CI: 6.0–7.8). The incidence of use, between 1999 and 2007, was 4.9% (95%CI: 4.2–5.7) for AD and 8.3% (95%CI: 7.3–9.3) for BDZ. The incidences of AD and BDZ use were higher among women and participants with a positive General Health Questionnaire. CONCLUSION: In this population, the increase in the use of AD was not accompanied by a decrease in the use of BDZ, showing the prescriptions for psychotropic medication do not follow the currently recommended guidelines for treatment of common mental health disorders

Senses of body image in adolescents in elementary school

OBJECTIVE : To comprehend the perception of body image in adolescence. METHODS : A qualitative study was conducted with eight focus groups with 96 students of both sexes attending four public elementary school institutions in the city of Rio de Janeiro, Southeastern Brazil, in 2013. An interview guide with questions about the adolescents’ feelings in relation to: their bodies, standards of idealized beauty, practice of physical exercise and sociocultural influences on self-image. In the data analysis we sought to understand and interpret the meanings and contradictions of narratives, understanding the subjects’ context and reasons and the internal logic of the group. RESULTS : Three thematic categories were identified. The influence of media on body image showed the difficulty of achieving the perfect body and is viewed with suspicion in face of standards of beauty broadcast; the importance of a healthy body was observed as standards of beauty and good looks were closely linked to good physical condition and result from having a healthy body; the relationship between the standard of beauty and prejudice, as people who are not considered attractive, having small physical imperfections, are discriminated against and can be rejected or even excluded from society. CONCLUSIONS : The standard of perfect body propagated by media influences adolescents’ self-image and, consequently, self-esteem and is considered an unattainable goal, corresponding to a standard of beauty described as artificial and unreal. However, it causes great suffering and discrimination against those who do not feel they are attractive, which can lead to health problems resulting from low self-esteem

Uso de tabaco entre idosos: revisão sistemática e meta-análise

The aim of this study was to combine the results of identified surveys on the prevalence of tobacco use in old age to estimate world prevalence of tobacco use and possible factors related to such behavior among the elderly. The literature search included electronic databases such as MEDLINE, LILACS, and Biological Abstracts, hand-searching of specialist journals and cited reference searches. The combined global prevalence was estimated using the random effects model. The total number of elderly subjects included in all surveys was 140,058, with data available from all the continents. Overall prevalence of tobacco use was 13% in both genders (22% male and 8% female). The prevalence rates were heterogeneous among surveys and were associated with smoking definition, questionnaire application, and country economic status. Few epidemiological studies assessed tobacco use among the elderly. A higher prevalence rate of tobacco use in males who live in higher income countries could be found, although additional evidence regarding elderly samples is still required.O objetivo deste estudo foi combinar os resultados de pesquisas identificadas sobre a prevalência do tabagismo em idosos, para estimar sua prevalência mundial e possíveis fatores relacionados a este tipo de comportamento entre eles. A revisão da literatura incluiu busca nas bases de dados eletrônicas como MEDLINE, LILACS e Biological Abstracts, busca manual em jornais especializados e nas referências citadas. A prevalência global combinada foi estimada usando-se o modelo de efeitos randômicos. O número total de idosos incluídos em todos os levantamentos foi 140.058, com dados disponíveis em todos os continentes. A prevalência de tabagismo foi de 13% em ambos os sexos (22% homens e 8% mulheres). As taxas de prevalência foram heterogêneas e estiveram associadas com a definição de tabagismo, aplicação do questionário e com a economia de cada país. A maior taxa de prevalência foi encontrada entre idosos do sexo masculino que vivem em países de renda mais alta.Universidade Federal do Rio de Janeiro Instituto de PsiquiatriaGlaxoSmithKline do BrasilUniversidade do Estado do Rio de Janeiro Faculdade de Ciências MédicasFundação Oswaldo Cruz Escola Nacional de Saúde Pública Sergio AroucaUniversidade Federal de São Paulo (UNIFESP) Departamento de PsiquiatriaUNIFESP, Depto. de PsiquiatriaSciEL

Prevalence of dynapenia and overlap with disability, depression, and executive dysfunction

OBJECTIVE: This study aims to investigate handgrip strength and dynapenia prevalence among older adults stratified by Brazilian macroregions. Additionally, we aim to evaluate the overlap between dynapenia and Instrumental Activities of Daily Living (IADL) disability, depression, and executive dysfunction on a national basis and by each Brazilian macroregion. METHODS: This cross-sectional analysis was based on data from the Brazilian Longitudinal Study of Aging (ELSI-Brazil). A multistage cluster sample design was used, with a representative population-based study of non-institutionalized community-dwelling Brazilians aged ≥ 50 years from 70 municipalities across all five macroregions of the country. The outcome variable was dynapenia. Covariables were IADL disability, depression, and executive dysfunction. The Brazilian macroregions were used for stratification. In addition, the following additional variables were included: age group, gender, education level, macroregions (North, Northeast, Southeast, South, and Midwest), self-reported health, multimorbidity, and falls. RESULTS: A total of 8,849 (94%) of the sample provided complete information for the handgrip strength assessment and were included in this analysis. Dynapenia prevalence was higher in North and Northeast regions (28.5% and 35.1%, respectively). We identified statistically significant differences between different macroregions for dynapenia, IADL disability, and verbal fluency, with worse values in the North and Northeast regions. In the North and Northeast macroregions, nearly half of the subjects that presented executive dysfunction and IADL disability also had dynapenia. There was a more significant overlap in the prevalence of all four conditions in the North and Northeast regions (4.8% and 5.5%, respectively), whereas the overlap was smaller in the South (2.3%). There was also a smaller overlap in the prevalence of dynapenia and depression in the South (5.8%) compared with other macroregions. CONCLUSIONS: Macroregions in Brazil exhibit marked differences in the prevalence of dynapenia and in its overlap with IADL disability, depression, and executive dysfunction

Verbal fluency in Alzheimer's disease, Parkinson's disease, and major depression

OBJECTIVE: To compare verbal fluency among Alzheimer's disease, Parkinson's disease, and major depression and to assess the sociodemographic and clinical factors associated with the disease severity. METHODS: Patients from an outpatient university center with a clinical diagnosis of Alzheimer's disease, Parkinson's disease or major depression were studied. Severity was staged using the Hoehn & Yahr scale, the Hamilton Depression scale and the Clinical Dementia Rating for Parkinson's disease, major depression, and Alzheimer's disease, respectively. All subjects were tested with the Mini-Mental State Examination, the digit span test, and the verbal fluency test (animals). We fit four types of regression models for the count variable: Poisson model, negative binomial model, zero-inflated Poisson model, and zero-inflated negative binomial model. RESULTS: The mean digit span and verbal fluency scores were lower in patients with Alzheimer's disease (n = 34) than in patients with major depression (n = 52) or Parkinson's disease (n = 17) (p<0.001). The average number of words listed was much lower for Alzheimer's disease patients (7.2 words) compared to the patients presenting with major depression (14.6 words) or Parkinson's disease (15.7 words) (KW test = 32.4; p<0.01). Major depression and Parkinson's disease groups listed 44% (ROM = 1.44) and 48% (ROM = 1.48) more words, respectively, compared to those patients with Alzheimer's disease; these results were independent of age, education, disease severity and attention. Independently of diagnosis, age, and education, severe disease showed a 26% (ROM = 0.74) reduction in the number of words listed when compared to mild cases. CONCLUSIONS: Verbal fluency provides a better characterization of Alzheimer's disease, major depression, and Parkinson's disease, even at later stages

Impact of Cognitive Behavioral Therapy on Resting Cardiac Parameters and Cortisol in Patients with Post-Traumatic Stress Disorder: A Pilot Randomized Clinical Trial

Post-Traumatic Stress Disorder (PTSD) has been associated with changes in psychophysiological and neuroendocrinal parameters. Cognitive Behavioral Therapy (CBT) is considered the treatment of choice for PTSD and is able to regularize altered neurobiological parameters; however, little is known about its effects on these parameters when measured during the therapeutic process. This pilot study aimed to evaluate the impact of CBT on cortisol and cardiac parameters measured at rest during the treatment of PTSD with comorbid major depression. 14 patients were randomized to four months of CBT or a waiting list. As expected, the experimental group had a greater reduction in PTSD symptoms and a large effect size. There was a reduction in the low frequency component of heart rate variability, which achieved borderline statistical significance and a large effect size. Salivary cortisol tended to track the progress of therapy, rising in the period of exposure and decreasing by the end of treatment. Despite the small sample size, this study opens the way for further research into the impact of CBT on the different biological markers of PTSD during the therapeutic process. This can hopefully help to optimize and personalize therapeutic studies while providing clues about modifications in bio behavioral pathological manifestations

The invisible patients: posttraumatic stress disorder in parents of individuals with cystic fibrosis

BACKGROUND: Besides the growing acknowledgment of the relevance of posttraumatic stress disorder (PTSD) related to medical illness, there is no study in cystic fibrosis yet. OBJECTIVE: To assess the prevalence of PTSD and the three clusters of posttraumatic stress symptoms (PTSS) in parents of patients with cystic fibrosis. METHODS: Parents of patients with cystic fibrosis (age range: 2 to 33 years) were drawn from the Cystic Fibrosis Association of the city of Rio de Janeiro. In this cross-sectional study, parents were asked to fulfill a questionnaire for social and demographic characteristics and were interviewed by means of the PTSD module of the Structured Clinical Interview for DSM-IV. RESULTS: The sample comprised 62 subjects (46 mothers and 16 fathers). Current prevalence for full PTSD was 6.5% and that for partial PTSD was 19.4%. Parents with and without PTSS differed significantly in two psychosocial aspects: the former reported more emotional problems (p = 0.001); and acknowledged more often the need for psychological or psychiatric interventions (p = 0.002) than the latter. However, only 6.3% of the parents with PTSS were in psychological/psychiatric treatment. DISCUSSION: This preliminary study showed that the frequency of PTSD symptoms is fairly high among parents of patients with cystic fibrosis, and although these parents recognize they have emotional problems and need psychological/psychiatric treatment, their suffering remains invisible to the medical system, leading to underdiagnosis and undertreatment.CONTEXTO: Apesar do crescente reconhecimento da relevância do transtorno de estresse pós-traumático (TEPT) secundário a doenças médicas, ainda não existem estudos em fibrose cística. OBJETIVO: Verificar a prevalência de TEPT e dos três grupos de sintomas de estresse pós-traumático em pais de pacientes com fibrose cística. MÉTODOS: Pais de pacientes com fibrose cística (idade média: 2 a 33 anos) foram recrutados da Associação Carioca de Mucoviscidose. Neste estudo transversal, os pais preencheram um questionário sociodemográfico e foram entrevistados por meio do módulo de TEPT do Structured Clinical Interview for DSM-IV. RESULTADOS: A amostra era composta de 62 indivíduos (46 mães e 16 pais). A prevalência atual de TEPT foi 6,5% e de TEPT parcial, de 19,4%. Os pais com e sem sintomas de TEPT diferiram significativamente em dois aspectos psicossociais: os primeiros relataram mais problemas emocionais (p = 0,001) e reconheceram mais frequentemente a necessidade de tratamento psiquiátrico ou psicológico (p = 0,002) que os últimos. Entretanto, somente 6,3% dos pais com sintomas de TEPT estavam em tratamento psiquiátrico/psicológico. CONCLUSÕES: Este estudo preliminar demonstrou que a frequência dos sintomas de TEPT é bem elevada em pais de pacientes com fibrose cística e, apesar de esses pais reconheceram que tem problemas emocionais e precisam de tratamento psiquiátrico/psicológico, seu sofrimento permanece invisível para o sistema médico, levando ao subdiagnóstico e ao subtratamento.Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ)Universidade Federal do Rio de Janeiro Instituto de PsiquiatriaUniversidade Federal Fluminense Departamento de Psiquiatria e Saúde MentalFundação Oswaldo Cruz Escola Nacional de Saúde PúblicaUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de Psiquiatria e Psicologia MédicaUNIFESP, EPM, Depto. de Psiquiatria e Psicologia MédicaSciEL

Income inequality and mental illness-related morbidity and resilience: a systematic review and meta-analysis

Background Studies of the association between income inequality and mental health have shown mixed results, probably due to methodological heterogeneity. By dealing with such heterogeneity through a systematic review and meta-analysis, we examine the association between income inequality, mental health problems, use of mental health services, and resilience (defined as the ability to cope with adversity). Methods We searched the Global Health, PsychARTICLES, PsycINFO, Social Policy and Practice, Embase and MEDLINE databases up to July 6, 2016, for quantitative studies of the association of income inequality with prevalence or incidence of mental disorders or mental health problems, use of mental health services, and resilience. Eligible studies used standardised instruments at the individual level, and income inequality at the aggregated, contextual, and ecological level. We extracted study characteristics, sampling, exposure, outcomes, statistical modelling, and parameters from articles. Because several studies did not provide enough statistical information to be included in a meta-analysis, we did a narrative synthesis to summarise results with studies categorised as showing either a positive association, mixed results, or no association. The primary outcome in the random-effects meta-analysis was mental health-related morbidity, defined as the prevalence or incidence of any mental health problem. This study is registered with PROSPERO, number CRD42016036377. Findings Our search identified 15 615 non-duplicate references, of which 113 were deemed potentially relevant and were assessed for eligibility, leading to the inclusion of 27 studies in the qualitative synthesis. Nine articles found a positive association between income inequality and the prevalence or incidence of mental health problems; ten articles found mixed results, with positive association in some subgroups and non-significant or negative association in other subgroups; and eight articles found no association between income inequality and mental health problems. Of the nine articles included in our meta-analysis, one reported a positive association between income inequality and mental health problems, six reported mixed results, and two reported no association. Pooled Cohen's d effect sizes for the association between income inequality and any mental disorder or mental health problems were 0·06 (95% CI 0·01–0·11) for any mental disorder, and 0·12 (0·05–0·20) for depressive disorders. Our meta-regression analysis showed that none of the factors considered (sample size, contextual level at which income inequality was assessed, quality assessment, type of instruments, and individual income as control variable) explained heterogeneity between studies (I2 89·3%; p<0·0001). Only one study investigated the association between income inequality and resilience; it found greater income inequality was associated with higher prevalence of depression only among individuals with low income. The only study of the role of income inequality as a determinant of the use of mental health services reported no association. Interpretation Income inequality negatively affects mental health but the effect sizes are small and there is marked heterogeneity among studies. If this association is causal and growing income inequality does lead to an increase in the prevalence of mental health problems, then its reduction could result in a significant improvement in population wellbeing