Somatization in Latin America: a review of the classification of somatoform disorders, functional syndromes and medically unexplained symptoms

OBJETIVO: Os sintomas sem explicação médica são frequentes e estão associados a sofrimento mental em vários contextos. Estudos prévios apontam que as populações latino-americanas são propensas à somatização. Diante da reformulação da Classificação Internacional de Doenças para sua 11ª edição, as particularidades dos nativos desta região do mundo devem ser levadas em consideração. O objetivo deste estudo é prover informações sobre somatização na população latino-americana para a tomada de decisões quanto às categorias diagnósticas ligadas a sintomas sem explicação médica na Classificação Internacional de Doenças-11ª edição. MÉTODO: Revisão extensa da produção de 1995 a 2011 sobre somatização em populações de origem latino-americana. RESULTADOS: A análise dos 106 estudos incluídos nesta revisão foi dividida em 15 categorias: revisões sistemáticas, revisões conceituais, prevalências, atenção primária, depressão e ansiedade, fatores de risco, violência, quadros orgânicos, relacionamento com profissionais e o sistema de saúde, etnia, síndromes ligadas à cultura, síndrome da fadiga crônica, fibromialgia, transtorno dismórfico corporal, e conversão e dissociação. CONCLUSÃO: Os estudos latino-americanos confirmam a dificuldade na definição categorial de quadros com sintomas sem explicação médica. O suposto "traço somatizador" das culturas latinas pode estar associado mais à expressão cultural e linguística do que a um caráter de natureza étnica, e tais particularidades devem estar na agenda na nova classificação destes fenômenos na Classificação Internacional de Doenças-11ª edição.OBJECTIVE: medically unexplained symptoms are common and associated with mental illness in various contexts. Previous studies show that Latin American populations are prone to somatization. Given the reformulation of the International Classification of Diseases towards its 11th edition the peculiarities of the population from this region of the world shall be taken into consideration. The objective of this study is to provide information on somatization in Latin American populations to help the decision making about medically unexplained symptoms diagnostic categories in the 11th edition of the International Classification of Diseases. METHOD: Extensive review of the academic production from 1995 to 2011 on somatization in populations of Latin American origin. RESULTS: The analysis of 106 studies included in this review was divided into 15 categories: systematic reviews, conceptual reviews, prevalence, primary care, depression and anxiety, risk factors, violence, organic conditions, relationship with health care, ethnicity, culture-bound syndromes, chronic fatigue syndrome, fibromyalgia, body dysmorphic disorder, and conversion and dissociation. CONCLUSION: The Latin American studies confirm the difficulty in defining medically unexplained symptoms categories. The supposed "somatizing trace" of Latin cultures may be linked more to cultural and linguistic expression than to an ethnic nature, and these peculiarities must be on the agenda for the new classification of these phenomena in the Classification of Diseases-11th edition

Atividade física e saúde mental: a associação entre exercício e humor

A atividade física é, por seus efeitos no tratamento e na prevenção de várias patologias, um importante instrumento de saúde pública, sendo útil, inclusive, no tratamento de doenças psiquiátricas como transtornos depressivos e ansiosos. Todavia, além dos benefícios, a atividade física também está associada a prejuízos para a saúde mental, aparecendo ligada a quadros como "exercício excessivo" e "síndrome de 'overtraining'", segundo alguns estudos. Trabalhos sobre os efeitos de atividade física na saúde mental vêm se tornando mais comuns, no entanto ainda não permitem um conhecimento maior sobre os mecanismos implicados nos benefícios e malefícios associados a este tipo de atividade. Este artigo procura revisar os conhecimentos disponíveis sobre as relações entre atividade física e saúde mental, principalmente no que se refere à ligação existente entre exercício e humor.Physical activity is an important public health tool used in the treatment and prevention of various physical diseases, as well as in the treatment of some psychiatric diseases such as depressive and anxiety disorders. However, studies have shown that in addition to its beneficial effects, physical activity can also be associated with impaired mental health, being related to disturbances like "excessive exercise" and "overtraining syndrome". Although the number of reports of the effects of physical activity on mental health is steadily increasing, these studies have not yet identified the mechanisms involved in the benefits and dangers to mental health associated with exercise. This article reviews the information available regarding the relationship between physical activity and mental health, specifically addressing the association between exercise and mood

Lifetime Prevalence, Age and Gender Distribution and Age-of-Onset of Psychiatric Disorders in the Sao Paulo Metropolitan Area, Brazil: Results from the Sao Paulo Megacity Mental Health Survey

Objectives: To estimate prevalence, age-of-onset, gender distribution and identify correlates of lifetime psychiatric disorders in the Sao Paulo Metropolitan Area (SPMA). Methods: The Sao Paulo Megacity Mental Health Survey assessed psychiatric disorders on a probabilistic sample of 5,037 adult residents in the SPMA, using the World Mental Health Survey Version of the Composite International Diagnostic Interview. Response rate was 81.3%. Results: Lifetime prevalence for any disorder was 44.8%; estimated risk at age 75 was 57.7%; comorbidity was frequent. Major depression, specific phobias and alcohol abuse were the most prevalent across disorders; anxiety disorders were the most frequent class. Early age-of-onset for phobic and impulse-control disorders and later age-of-onset for mood disorders were observed. Women were more likely to have anxiety and mood disorders, whereas men, substance use disorders. Apart from conduct disorders, more frequent in men, there were no gender differences in impulse-control disorders. There was a consistent trend of higher prevalence in the youngest cohorts. Low education level was associated to substance use disorders. Conclusions: Psychiatric disorders are highly prevalent among the general adult population in the SPMA, with frequent comorbidity, early age-of-onset for most disorders, and younger cohorts presenting higher rates of morbidity. Such scenario calls for vigorous public health action.State of Sao Paulo Research Foundation (FAPESP) [03/00204-3]State of Sao Paulo Research Foundation (FAPESP)Vitoria Foundation for Science and Technology (FACITEC) [002/2003]Vitoria Foundation for Science and Technology (FACITEC)Sao Paulo State Secretaria de Seguranca Publica, through Professor Wagner Farid GattazSao Paulo State Secretaria de Seguranca Publica, through Professor Wagner Farid GattazUnited States National Institute of Mental Health [R01MH070884]United States National Institute of Mental HealthJohn D. and Catherine T. MacArthur FoundationJohn D. and Catherine T. MacArthur FoundationPfizer FoundationPfizer FoundationU.S. Public Health Service [R13-MH066849, R01-MH069864, R01 DA016558]US Public Health ServiceFogarty International CenterFogarty International Center [FIRCA R03-TW006481]Pan American Health OrganizationPan American Health OrganizationEli Lilly & Company FoundationEli Lilly & Company FoundationOrthoMcNeil Pharmaceutical, Inc.Ortho-McNeil Pharmaceutical, Inc.GlaxoSmithKlineGlaxoSmithKlineBristolMyers SquibbBristol-Myers SquibbShireShir

Epidemologia psiquiátrica. Novos desafios para o século XXI

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Treatment of anxiety disorders in clinical practice: a critical overview of recent systematic evidence

The aim of this study was to review emerging evidence of novel treatments for anxiety disorders. We searched PubMed and EMBASE for evidence-based therapeutic alternatives for anxiety disorders in adults, covering the past five years. Eligible articles were systematic reviews (with or without meta-analysis), which evaluated treatment effectiveness of either nonbiological or biological interventions for anxiety disorders. Retrieved articles were summarized as an overview. We assessed methods, quality of evidence, and risk of bias of the articles. Nineteen systematic reviews provided information on almost 88 thousand participants, distributed across 811 clinical trials. Regarding the interventions, 11 reviews investigated psychological or nonbiological treatments; 5, pharmacological or biological; and 3, more than one type of active intervention. Computerdelivered psychological interventions were helpful for treating anxiety of low-to-moderate intensity, but the therapist-oriented approaches had greater results. Recommendations for regular exercise, mindfulness, yoga, and safety behaviors were applicable to anxiety. Transcranial magnetic stimulation, medication augmentation, and new pharmacological agents (vortioxetine) presented inconclusive benefits in patients with anxiety disorders who presented partial responses or refractoriness to standard treatment. New treatment options for anxiety disorders should only be provided to the community after a thorough examination of their efficacy

Attention deficit/hyperactivity disorder symptoms in indigenous children from the Brazilian Amazon

The clinical constructs of attention deficit/hyperactivity disorder (ADHD) have been described in several cultures worldwide. Yet this symptomatic presentation still remains to be assessed in remote population groups. Objective: To explore the possibility of the existence of ADHD symptoms among settlement-dwelling indigenous children of the Karaja ethnic group. in the Brazilian Amazon and to estimate the rate of ADHD symptoms among 7-16-year-olds. Method: All parents/caretakers of 7-16-year olds from all (N=5) most populated indigenous groups were invited to participate, if they were worried about their children emotional/behavioural problems. Fifty three parents spontaneously came for a psychiatric interview (DSM-IV criteria applied), individually conducted at the settlement's health post by a child psychiatrist. Results: the estimated rate of ADHD symptoms in problematic indigenous children aged 7-16 years was 24.5% (95% Cl: 13.6-35.4) since 13 out of 53 parents/caretakers reported the classical triad of ADHD symptoms (inattentiveness, hyperactivity, impulsiveness). Conclusion: ADHD is a clinically relevant construct in the Karaja indigenous population, representing a major concern among parents/caretakers of children and adolescents from this ethnic group.Univ Fed Goias, Sch Med, PUC Goias, Goiania, Go, BrazilUniv São Paulo, Sch Med, Sect Psychiat Epidemiol LIM 23, Dept & Inst Psychiat, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Psychiat, Paulista Sch Med, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Psychiat, Paulista Sch Med, São Paulo, BrazilWeb of Scienc

Gender differences in drinking patterns and alcohol-related problems in a community sample in São Paulo, Brazil

OBJECTIVE: To investigate drinking patterns and gender differences in alcohol-related problems in a Brazilian population, with an emphasis on the frequency of heavy drinking. METHODS: A cross-sectional study was conducted with a probability adult household sample (n = 1,464) in the city of São Paulo, Brazil. Alcohol intake and ICD-10 psychopathology diagnoses were assessed with the Composite International Diagnostic Interview 1.1. The analyses focused on the prevalence and determinants of 12-month nonheavy drinking, heavy episodic drinking (4-5 drinks per occasion), and heavy and frequent drinking (heavy drinking at least 3 times/week), as well as associated alcohol-related problems according to drinking patterns and gender. RESULTS: Nearly 22% (32.4% women, 8.7% men) of the subjects were lifetime abstainers, 60.3% were non-heavy drinkers, and 17.5% reported heavy drinking in a 12-month period (26.3% men, 10.9% women). Subjects with the highest frequency of heavy drinking reported the most problems. Among subjects who did not engage in heavy drinking, men reported more problems than did women. A gender convergence in the amount of problems was observed when considering heavy drinking patterns. Heavy and frequent drinkers were twice as likely as abstainers to present lifetime depressive disorders. Lifetime nicotine dependence was associated with all drinking patterns. Heavy and frequent drinking was not restricted to young ages. CONCLUSIONS: Heavy and frequent episodic drinking was strongly associated with problems in a community sample from the largest city in Latin America. Prevention policies should target this drinking pattern, independent of age or gender. These findings warrant continued research on risky drinking behavior, particularly among persistent heavy drinkers at the non-dependent level

Funcionalidad y soledad en personas mayores: Modelo de mediación por el afecto positivo

Objective:Research has shown that loneliness is associated with functional disability in the older population. However, little is known about the role of affectivity in this relationship. The present study explored a mediation model in which affectivity was hypothesized to mediate the relationship between functionality and loneliness, controlling for the effect of relevant variables.Methods:The University of California Loneliness Scale-16 items, Geriatric Functionality Scale, Positive and Negative AffectSchedule-14, and Geriatric Depression Scale-8 were administered to 489 old adults (65–100 years old), 428 from social care homes (SCH), and 61 from the community.Results:Those from SCH, women, widowed, withlow education, more functional disability, more negative affect, less positive affect, and more depressive symptoms reported more loneliness. Controlling for the effect of depressive symptoms, gender, residential status, marital status, and education, only positive affect mediated, partially, the relationship between functionality and loneliness. Conclusion:We suggest implementing interventions that increase older adults' insights in personalized patterns of positive affect and, consequently, ease feelings of loneliness in older people suffering from functional limitations (especially women, with depressive symptoms, widowed, residing in an institution, and with low educational level)Objetivo: La soledad se asocia a la discapacidad funcional en la población mayor, aunque se sabe poco sobre el papel de la afectividad en esta relación. Nos proponemos explorar el efecto mediador de la afectividad en la relación entre funcionalidad y soledad, controlando el efecto de las variables relevantes. Métodos: Se administró la Escala de Soledad de la Universidad de California-16, la Escala de Funcionalidad Geriátrica, las Escalas de Afecto Positivo y Negativo-14 y la Escala de Depresión Geriátrica-8 a 489 adultos mayores (65–100 años), 428 de residencias geriátricas y 61 de la comunidad. Resultados: Los residentes en una institución, mujeres, viudos, con baja educación, más discapacidad funcional, más afecto negativo, menos afecto positivo y más síntomas depresivos reportaron más soledad. Controlando el efecto de los síntomas depresivos, género, situación residencial, estado civil y educación, solo el afecto positivo medió, parcialmente, la relación entre funcionalidad y soledad. Conclusión: Se sugieren intervenciones para aumentar la concienciación por parte de los adultos mayo-res en los perfiles personalizados de afecto positivo, aliviando así los sentimientos de soledad en los que sufren limitaciones funcionales (especial-mente mujeres, con síntomas depresivos, viudos, residiendo en una institución y con bajo nivel educativo)

São Paulo megacity - um estudo epidemiológico de base populacional avaliando a morbidade psiquiátrica na região metropolitana de São Paulo: objetivos, desenho e implementação do trabalho de campo

The São Paulo Megacity Mental Health Survey is a population-based cross-sectional survey of psychiatric morbidity, assessing a probabilistic sample of household residents in the São Paulo Metropolitan Area, aged 18 years and over. Respondents were selected from a stratified multistage clustered area probability sample of households, covering all 39 municipalities, without replacement. Respondents were assessed using the World Mental Health Survey version of the World Health Organization Composite International Diagnostic Interview (WMH-CIDI), which was translated and adapted into the Brazilian-Portuguese language. Data was collected between May 2005 and April 2007 by trained lay interviewers. The World Mental Health Survey version of the Composite International Diagnostic Interview comprises clinical and non-clinical sections, arranged as Part I and Part II, producing diagnoses according to the Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition, and the International Classification of Diseases - 10th Revision. Mood, anxiety, impulse-control and substance use disorders, and suicide-related behavior, considered core disorders, as well as socio-demographic information, were assessed in all respondents. Non-clinical modules and non-core clinical sections (obsessive-compulsive disorder, post-traumatic stress disorder, gambling, eating disorders, neurasthenia, pre-menstrual disorders, psychotic symptoms and personality traits) were assessed in a sub-sample (2,942 respondents), composed by all respondents with at least one core disorder and a 25% random sample of those who were non-cases. A total of 5,037 individuals were interviewed, with a global response rate of 81.3%. Saliva samples were collected from 1,801 respondents, with DNA extracted stored pending further investigations.O Estudo Epidemiológico dos Transtornos Mentais São Paulo Megacity é um estudo de corte transversal de base populacional avaliando a morbidade psiquiátrica em uma amostra probabilística da população geral residente na Região Metropolitana de São Paulo, com 18 anos ou mais. Respondentes foram selecionados através de um processo probabilístico multiestratificado de domicílios, cobrindo os 39 municípios, sem substituição. Respondentes foram avaliados usando a versão desenvolvida para o Estudo Mundial de Saúde Mental (World Mental Health Survey) do Composite International Diagnostic Interview da Organização Mundial da Saúde, que foi traduzido e adaptado para o Português vigente no Brasil. A coleta de dados ocorreu entre maio/2005 e abril/2007, por entrevistadores treinados. O WMH-CIDI é composto por seções clínicas e não-clínicas, dispostas em duas partes, gerando diagnósticos de acordo com o Manual Diagnóstico e Estatísticos de Doenças Mentais - Quarta Edição e a Classificação Internacional de Doenças - 10ª Revisão. Todos os respondentes receberam os módulos de avaliação de transtornos do humor, de ansiedade, do controle de impulsos, decorrentes do uso de substâncias psicoativas e comportamento suicida, considerados transtornos nucleares, assim como foram coletados dados sociodemográficos. Módulos não-clínicos e clínicos complementares (transtornos obsessivo-compulsivos, estresse pós-traumático, jogo patológico, alimentares, pré-menstruais, neurastenia, sintomas psicóticos e rastreio de personalidade) foram aplicados àqueles que tiveram pelo menos um dos transtornos nucleares e a uma amostra aleatória de 25% dos negativos (2.942 respondentes). Um total de 5.037 indivíduos foi entrevistado, com uma taxa global de resposta de 81,3%. Amostras de saliva foram coletadas de 1.801 respondentes, com extração de DNA e armazenamento para investigação futura.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Fundo de Apoio à Ciência e Tecnologia do Município de Vitória(NIH/NIMH) United States National Institute of Mental HealthMacArthur FoundationPfizer FoundationUS Public Health Service(NIH) Fogarty International Cente

Epidemiologia dos transtornos de ansiedade em regiões do Brasil: uma revisão de literatura

Aim: To identify the frequency, the determining factors and the use of health services available for the treatment of anxiety disorders in Brazil. Methods: The searches were performed in the following databases: PubMed, LILACs and Google Scholar, covering the last 10 years. The descriptors were: “epidemiology”, “anxiety disorders”, “prevalence” and “Brazil”. Articles containing original data from representative samples of the community were selected. Inclusion criteria: anxiety disorders should have been assessed through standardized diagnostic interviews. Results: The year-prevalence of anxiety disorders in some regions of Brazil (mainly southeastern and southern regions) was high, reaching 19.9% and life prevalence of 28.1% in the metropolitan region of São Paulo. The prevalence ratio, or the relationship between the rate in the last year and throughout life, was 0.71, showing the high persistence of anxiety disorders. Some sociodemographic factors and comorbidity with other mental (especially depression) and physical disorders were associated with anxiety. The most persistent conditions were those most associated with physical comorbidity and chronic diseases. Only 23% of respondents (with the highest healthcare seeking among patients with panic disorder) had some form of healthcare in the year prior to the interview. Discussion: In the regions included in the present review, anxiety disorders represent the most prevalent psychiatric condition among the studies that have assessed other mental disorders, whose course had high persistence or chronicity. Compared with high-income countries, there is some evidence that the proportion of individuals who have received some form of treatment in our country is lower. Based on the data collected, it was found that most of the studies evaluated comment on the importance of implementing comprehensive public services in order to provide a support network for the population in need.Objetivo: Identificar a frequência, os fatores determinantes e o uso de serviços de saúde disponíveis para o tratamento dos transtornos ansiosos no Brasil. Métodos: As buscas foram realizadas nas seguintes bases de dados: PubMed, LILACS e Google Acadêmico, cobrindo os 10 últimos anos. Os descritores foram: “epidemiologia”, “transtornos de ansiedade”, “prevalência” e “Brasil”. Foram selecionados os artigos com dados originais, de amostras representativas da comunidade. Critérios de inclusão: os transtornos de ansiedade devem ter sido avaliados por meio de entrevistas diagnósticas padronizadas. Resultados: A prevalência-ano de transtornos ansiosos em algumas regiões do Brasil (principalmente regiões sudeste e sul) foi elevada, chegando a 19,9% e prevalência-vida de 28,1% na região metropolitana de São Paulo. A razão de prevalência, ou a relação entre a taxa no último ano e ao longo da vida, foi de 0,71, mostrando a alta persistência dos transtornos ansiosos. Alguns fatores sociodemográficos e a comorbidade com outros transtornos mentais (principalmente com a depressão) e fïsicos foram associados com a ansiedade. Os quadros mais persistentes foram os mais associados com a comorbidade física e doenças crônicas. Somente 23% dos indivíduos entrevistados (com a maior procura entre os pacientes com transtorno do pânico) obtiveram alguma forma de tratamento de saúde no ano anterior à entrevista. Discussão: Nas regiões incluídas na presente revisão, os transtornos ansiosos representam a condição psiquiátrica mais prevalente entre os estudos que avaliaram outros transtornos mentais, cujo curso apresentou alta persistência ou cronicidade. Em comparação com países de alta renda, há alguns indícios que a proporção de indivíduos que obtiveram alguma forma de tratamento no nosso meio seja menor. Com base nos dados levantados, constatou-se que grande parte dos estudos avaliados comenta sobre a importância de implementar serviços públicos abrangentes, a fim de fornecer uma rede de apoio para as necessidades da população