Etiological treatment in psychiatry: the neurosyphilis model

This paper aims to study the historical evolution and describe the impact of modern antibiotic therapy on psychiatric hospital admissions. The data was collected in the hospital data bank with records of patients admissions from 1931 to 1991. Patients were classified by name, sex, age, marital status, social class, nationality, place of birth, occupation, number of admissions by neurosyphilis and other diagnosis as also date of admission and state of health at time of leaving hospital, and this information was used in the statistical analysis. The classification system of diagnosis is that used by WHO ICD - 9. The results show decreasing rates of admissions by neurosyphilis after the introduction of penicillin in 1948 (19%) to the last admission in the historical cohort in 1968. The antibiotics (penicillin) change the natural evolution of the disease and its pattern of morbidity and mortality. The therapeutical impact of antibiotics in the incidence and prevalence of hospitalization rates of neurosyphilis is never observed in any other psychiatric disease.Este trabalho tem como objetivo estudar a evolução histórica, durante 60 anos, das admissões por diagnóstico de neurossífilis em um hospital psiquiátrico e descrever o impacto da moderna antibioticoterapia. Foi baseado nos dados e planilhas do hospital psiquiátrico em estudo, de 1931 à 1991. O banco de dados do hospital contém informações do tipo: nome, sexo, idade, estado civil, nacionalidade, procedência, profissão, classe social, número de admissões por neurossífilis e outros diagnósticos, data de admissão, data de alta e diagnóstico pelo CID 9/WHO. A análise estatística envolveu todas as admissões até o último registro de paciente com diagnóstico de neurossífilis e comparado com resultados por outros tipos de admissões. Observou-se que antes da introdução da penicilina, nos serviços de saúde de Pelotas, em 1948, 19% das admissões eram por neurossífilis. Depois, os registros hospitalares descrevem uma tendência decrescente até a última admissão em 1968. O impacto da antibioticoterapia na história natural da neurossífilis foi o maior até hoje e nunca antes visto com outros recursos terapêuticos (biológicos, psicofarmacológicos e psicoterápicos), para outras doenças psiquiátricas.UCPel.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de PsiquiatriaUNIFESP, EPM, Depto. de PsiquiatriaSciEL

Validation of the Portuguese version of the Lithium Attitudes Questionnaire (LAQ) in bipolar patients treated with lithium: cross-over study

BACKGROUND: Poor adherence to lithium is very common in bipolar patients and it is a frequent cause of recurrence during prophylactic treatment. Several reports suggest that attitudes of bipolar patients interfere with adherence to lithium. The Lithium Attitudes Questionnaire (LAQ) is a brief questionnaire developed as a means of identifying and grouping the problems patients commonly have with taking lithium regularly. The original version is validated in patients, but a validated version in Portuguese is not yet available. METHODS: One-hundred six patients with bipolar disorder (DSM-IV criteria) criteria under lithium treatment for at least one month were assessed using LAQ. LAQ is a brief questionnaire administered under interview conditions, which includes 19 items rating attitudes towards prophylactic lithium treatment. We analysed the internal consistency, concurrent validity, sensitivity and specificity of the Portuguese version of LAQ. RESULTS: The internal consistency, evaluated by Cronbach's alpha was 0.78. The mean total LAQ score was 4.1. Concurrent validity was confirmed by a negative correlation between plasma lithium concentration and total LAQ score (r = -0,198; p = 0.048). We analysed the scale's discriminative capacity revealing a sensitivity of 69% and a specificity of 71% in the identification of negative attitudes of bipolar patients. CONCLUSION: The psychometric assessment of the Portuguese version of LAQ showed good internal consistency, sensitivity and specificity. The results were similar to the original version in relation to attitudes of bipolar patients towards lithium therapy

Adaptation and validation of the Portuguese version of the Lithium Knowledge Test (LKT) of bipolar patients treated with lithium: cross-over study

OBJECTIVE: Adherence problems are a common feature among bipolar patients. A recent study showed that lithium knowledge was the main difference between adherent and non adherents bipolar patients. The Lithium Knowledge Test (LKT), a brief questionnaire, was developed as a means of identifying aspects of patients' practical and pharmacological knowledge which are important if therapy is to be safe and effective. The original English version is validated in psychiatric population, but a validated Portuguese one is not yet available. METHODS: One hundred six patients selected were diagnosed with bipolar disorder (I or II) according to DSM-IV criteria and had to be on lithium treatment for at least one month. The LKT was administered on only one occasion. We analysed the internal consis tency, concurrent validity, sensitivity and specificity of the LKT for the detection of the knowledge about lithium treatment of bipolar patients. RESULTS: The internal consistency, evaluated by Cronbach's alpha was 0.596. The mean of total score LKT by bipolar patients was 9.0 (SD: 0.75) for men and 8.74 (SD: 0.44) for women. Concurrent validity based on plasma lithium concentration showed a significant correlation between the total LKT score and plasma lithium (r = 0,232; p = 0.020). The sensitivity was 84% and specificity was 81%. CONCLUSION: LKT is a rapid, reliable instrument which appears to be as effective as a lengthier standard interview with a lithium clinic doctor, and which has a high level of acceptability to lithium patients. We found that the psychometric assessment of the Portuguese version of LKT showed good internal consistency, sensitivity and specificity

Tratamento farmacológico do transtorno bipolar: as evidências de ensaios clínicos randomizados

The present article is a synthesis of the published clinical trials about the treatment of Bipolar disorder (BD). The methodology used to search the literature is described and results are presented. Using the best available evidence (systematic reviews of clinical trials or at lest one randomized clinical trial) the following is recommended: 1) acute mania can be treated with lithium, carbamazepine, valrpoate and antipsychotics; 2) acute depression can be treated with lamotrigine, olanzapine/fluoxetine combination and with antidepressants (with an increased risk of switch into mania); 3) maintenance can be performed using lithium, valproate, olanzapine and lamotrigine (when the aim is prophylaxis of bipolar depression). The absence of published results about certain interventions does not mean that such interventions are not useful.O presente artigo é uma síntese das evidências provenientes de ensaios clínicos randomizados sobre o tratamento do transtorno bipolar. A metodologia para a busca do material disponível é descrita, e os resultados são apresentados. Com o melhor nível de evidência disponível, ou seja, revisões sistemáticas de mais de um ensaio clínico randomizado ou pelo menos um ensaio clínico randomizado, temos as seguintes recomendações: 1) a mania aguda pode ser tratada com Lítio, Valproato, Carbamazepina, e antipsicóticos; 2) a depressão bipolar pode ser tratada com antidepressivos (com risco aumentado de virada para mania), com lamotrigina e a associação fluoxetina/olanzapina e 3) a manutenção do transtorno bipolar pode ser realizada com o lítio, valproato, carbamazepina, olanzapina e lamotrigina (quando o objetivo for a profilaxia da depressão bipolar). A não existência de ensaios clínicos publicados não significa que determinadas intervenções não sejam úteis

Depressive symptoms and associated factors in an elderly population in southern Brazil

OBJECTIVE: To determine the frequency of some depressive symptoms in the elderly, to build up a score of depressive symptoms and to evaluate the association between depressive symptoms and demographic, socioeconomic and behavioral variables. METHODS:A population-based cross-sectional study was conducted in individuals aged 60 and more living in the urban city area of Pelotas, Brazil. The sample was selected in multiple stages based on the city's census tracts. It was used a questionnaire comprising eight question commonly included in depression evaluation instruments and specific to the elderly. Analyses were carried out using multiple linear regressions following a hierarchical approach. RESULTS: A total of 583 subjects were interviewed and non-response rate was 4.7%. Each participant had on the average score of depressive symptoms was 3.4 (SD 2.1)Lack of willingness to carry out daily activities was the most frequent symptom (73.9%) reported. In the adjusted analysis according to the conceptual framework, the following groups had statistically higher averages (pOBJETIVOS: Determinar a freqüência de alguns sintomas depressivos em idosos, construir um escore de sintomas depressivos, e avaliar a associação entre a média de sintomas depressivos e variáveis demográficas, socioeconômicas e comportamentais. MÉTODOS: Delineamento transversal de base populacional incluindo indivíduos com 60 anos ou mais residentes na zona urbana da cidade de Pelotas, RS. A amostragem foi realizada em múltiplos estágios, tendo por base os setores censitários do município. Utilizou-se um instrumento com oito sintomas comumente incluídos em questionários e escalas de depressão e específicos de erosão afetiva (forma esta mais comum de manifestação depressiva entre idosos). A análise foi feita por regressão linear múltipla e se baseou em um modelo conceitual de determinação do desfecho. RESULTADOS: Foram entrevistados 583 sujeitos, sendo que o percentual de perdas e recusas foi de 4,7%. A média dos sintomas depressivos por participante foi de 3,4 (dp=2,1). A ausência de disposição para realizar as atividades habituais foi o sintoma mais freqüente (73,9%). Na análise ajustada, os seguintes grupos apresentaram médias estatisticamente maiores (

Polarity of the First Episode and Time to Diagnosis of Bipolar I Disorder

Objective The current study explored the relationship between the polarity of the first episode and the timing of eventual diagnosis of bipolar I disorder, and associated clinical implications. Methods Twelve years of clinical data from the medical records of 258 inpatients meeting DSM-III-R or DSM-IV criteria for bipolar I disorder were analyzed. Subjects were divided into two groups according to the polarity of the first episode: those with depressive polarity (FE-D), and those with manic polarity (FE-M). Comparisons were made between the two groups on variables associated with the timing of diagnosis and related outcomes. Results In Population with bipolar I disorder, a significant longer time lapse from the first major mood episode to the confirmed diagnosis was associated with the FE-D group compared to the FE-M group [5.6 (+/- 6.1) vs. 2.5 (+/- 5.5) years, p<0.001]. FE-D subjects tended to have prior diagnoses of schizophrenia and major depressive disorder while FE-M subjects tended to have prior diagnoses of bipolar disorder and schizophrenia. A significantly higher rate of suicide attempts was associated with the FE-D group compared to the FE-M group (12.7 vs. 1.7%, p<0.001). Conclusion The results of this study indicate that first-episode depressive polarity is likely to be followed by a considerable delay until an eventual confirmed diagnosis of bipolar I disorder. Given that first-episode depressive patients are particularly vulnerable to unfavorable clinical Outcomes Such as suicide attempts, a more systematic approach is needed to differentiate bipolar disorder among depressed patients in their early stages.Rosa AR, 2008, J AFFECT DISORDERS, V107, P45, DOI 10.1016/j.jad.2007.07.021Chaudhury SR, 2007, J AFFECT DISORDERS, V104, P245, DOI 10.1016/j.jad.2007.02.022Berk M, 2007, J AFFECT DISORDERS, V103, P181, DOI 10.1016/j.jad.2007.01.027Benazzi F, 2007, LANCET, V369, P935GOODWIN FK, 2007, MANIC DEPRESSIVE ILLDaban C, 2006, COMPR PSYCHIAT, V47, P433, DOI 10.1016/j.comppsych.2006.03.009McElroy SL, 2006, BIPOLAR DISORD, V8, P596Kassem L, 2006, AM J PSYCHIAT, V163, P1754Colom F, 2006, J AFFECT DISORDERS, V93, P13, DOI 10.1016/j.jad.2006.01.032Perlis RH, 2005, AM J MANAG CARE, V11, pS271Perlis RH, 2005, BIOL PSYCHIAT, V58, P549, DOI 10.1016/j.biopsych.2005.07.029Gazalle FK, 2005, J AFFECT DISORDERS, V86, P313, DOI 10.1016/j.jad.2005.01.003Ghaemi SN, 2005, J AFFECT DISORDERS, V84, P273, DOI 10.1016/S0165-0327(03)00196-4Post JC, 2005, CURR OPIN ALLERGY CL, V5, P5Mitchell PB, 2004, BIPOLAR DISORD, V6, P530Goodwin FK, 2003, JAMA-J AM MED ASSOC, V290, P1467Morselli PL, 2003, BIPOLAR DISORD, V5, P265Daniels BA, 2003, J AFFECT DISORDERS, V75, P163, DOI 10.1016/S0165-0327(02)00041-1Baethge C, 2003, ACTA PSYCHIAT SCAND, V107, P260Hirschfeld RMA, 2003, J CLIN PSYCHIAT, V64, P161Goldberg JF, 2002, J CLIN PSYCHIAT, V63, P985Ghaemi SN, 2002, CAN J PSYCHIAT, V47, P125Suppes T, 2001, J AFFECT DISORDERS, V67, P45Hirsch M, 2001, YALE J CRIT, V14, P5Bowden CL, 2001, PSYCHIATR SERV, V52, P51Hirschfeld RMA, 2000, AM J PSYCHIAT, V157, P1873Ghaemi SN, 2000, J CLIN PSYCHIAT, V61, P804Perugi G, 2000, COMPR PSYCHIAT, V41, P13GHAEMI SN, 2000, J CLIN PSYCHIAT, V61, P809Ghaemi SN, 1999, J AFFECT DISORDERS, V52, P135Baldessarini RJ, 1999, J CLIN PSYCHIAT, V60, P77BALDESSARINI RJ, 1999, J CLIN PSYCHIAT S2, V60, P111LISH JD, 1994, J AFFECT DISORDERS, V31, P281WEHR TA, 1988, AM J PSYCHIAT, V145, P179