Prevalência da depressão maior nos pacientes em hemodiálise crônica

OBJECTIVES: Depression is a prevalent condition and has an important impact on the outcome of patients with end-stage renal failure. Our main objective is to determine the prevalence of major depression in patients on hemodialysis at the Hospital de Clínicas de Porto Alegre. It is also our objective to verify the prevalence of other conditions included in a range of depressive disorders and to describe our population. MATERIALS AND METHODS: Data were collected through a single interview with patients and through review of medical records. RESULTS: Forty-one patients were investigated, out of which 22 (53.66%) did not fulfill any of the criteria for depression; 10 (24.39%) had major depression (PRIME-MD); 5 (12.19%) had partial remission of major depressive disorder; 4 (9.76%) had minor depressive disorder; and 5 (12.19%) had dysthymia and concomitant major depression. Consequently, 19 (46.34%) patients presented at least one of the depressive disorders included in this study. CONCLUSION: Our study is in agreement with the literature in that our population indicated a relevant association of end-stage renal disease with depression in patients on hemodialysis. Healthcare professionals should be aware of this situation and be prepared to operate towards providing a better quality of life for these patients.OBJETIVOS: A depressão é uma condição prevalente e apresenta um impacto importante na evolução de pacientes com insuficiência renal crônica em estágio terminal. O presente estudo tem como objetivo primário estabelecer a prevalência de depressão maior nos pacientes em hemodiálise do Hospital de Clínicas de Porto Alegre (HCPA). Como objetivos secundários estão verificar a prevalência de alguns outros transtornos que compõem o chamado "espectro depressivo" e caracterizar os grupos de pacientes encontrados. PACIENTES E MÉTODOS: Os dados foram coletados através de entrevista única com os pacientes e consulta ao prontuário. RESULTADOS: De um total de 41 pacientes avaliados, 22 (53,66%) não preenchiam critérios para quaisquer dos transtornos pesquisados, 10 (24,39%) receberam diagnóstico de depressão maior de acordo com o instrumento utilizado, o PRIME-MD, 5 (12,19%) apresentavam remissão parcial de transtorno depressivo maior, 4 (9,76%) apresentavam transtorno depressivo menor e 5 (12,19%) apresentavam distimia (essa última ocorrendo em todos os casos concomitante com depressão maior). Considerando o "espectro depressivo", têm-se 19 pacientes (46,34%) nesse grupo. CONCLUSÃO: Assim como na literatura, também em nosso meio constatamos a relevante associação entre depressão e insuficiência renal crônica em estágio terminal nos pacientes em hemodiálise e depressão. A equipe de saúde deve estar alerta para essa situação e preparada para um manejo que propicie a melhor qualidade de vida possível para esses pacientes

"Quality of life": a brand new concept for research and practice in psychiatry

Since the '70s, the assessment of quality of life (QOL) has grown from a 'small cottage' industry to a formal discipline within a coherent theoretical framework, accepted methods, and manifold applications. In recent years, QOL has become increasingly popular as a useful variable tailored to assess the overall impact of diseases and medical treatments from the patient's point of view. In this updating paper, we describe the most frequently used instruments, and discuss the conceptual and practical issues concerning QOL evaluation, as applied to the study of mental disorders. In addition, we present a unifying definition of QOL that has recently been developed by the World Health Organization. Finally, we conclude that QOL measures are potentially useful methods to be applied to research and clinical practice in psychiatry - especially when used to demonstrate the impact of mental illnesses and the possible benefits of therapeutic interventions

Transtorno de estresse pós-traumático e depressão maior Posttraumatic stress disorder and major depression

Estudos epidemiológicos indicam, claramente, que o transtorno de estresse pós-traumático (TEPT) está se tornando um importante problema de saúde em termos globais, ainda que continue sendo pouco diagnosticado e tratado de forma inapropriada. O TEPT comumente ocorre em comorbidade com outros transtornos psiquiátricos, especialmente com a depressão maior. Entretanto, a relação entre esses transtornos e o tratamento dessa complexa entidade clínica apenas recentemente passou a receber atenção da literatura especializada. Alguns autores argumentaram que elas são duas entidades distintas, enquanto outros defenderam a hipótese de que a alta prevalência dessa comorbidade pode representar um artefato derivado dos critérios diagnósticos atualmente utilizados. Com relação ao tratamento do TEPT comórbido com depressão maior, os dados disponíveis na literatura são insuficientes e não apontam para nenhuma abordagem específica, embora alguns ensaios clínicos pequenos tenham relatado a utilidade da combinação de inibidores seletivos da recaptação da serotonina com terapia cognitiva.<br>Epidemiological studies clearly indicate that posttraumatic stress disorder (PTSD) is becoming a major health concern worldwide even if still poorly recognized and not well treated. PTSD commonly co-occurs with other psychiatric disorder, especially with major depression. However, the relationship between these disorders and the treatment of this complex clinical entity are only now being addressed in the specialized literature. Some authors argued that they are two distinct entities, whereas others defended the hypothesis that the high prevalence of this comorbidity may represent an artifact derived from the diagnostic criteria currently used. Regarding the treatment of PSTD comorbid with major depression, the available data from controlled studies are insufficient to point out for a specific approach, although some small trials reported the usefulness of combining selective serotonin reuptake inhibitors and cognitive therapy

The Dorsolateral Prefrontal Cortex Plays a Role in Self-Initiated Elaborative Cognitive Processing during Episodic Memory Encoding: rTMS Evidence

<div><p>During episodic memory encoding, elaborative cognitive processing can improve later recall or recognition. While multiple studies examined the neural correlates of encoding strategies, few studies have explicitly focused on the self-initiation of elaborative encoding. Repetitive transcranial magnetic stimulation (rTMS), a method which can transiently disrupt neural activity, was administered during an associative encoding task. rTMS was either applied to the left dorsolateral prefrontal cortex (DLPFC) or to the vertex (a control region not involved in memory encoding) during presentation of pairs of words. Pairs could be semantically related or not related. Two encoding instructions were given, either cueing participants to analyze semantic relationships (cued condition), or to memorize the pair without any specific strategy cues (the self-initiated condition). Participants filled out a questionnaire regarding their use of memory strategies and performed a cued-recall task. We hypothesized that if the DLPFC plays a role in the self-initiation of elaborative encoding we would observe a reduction in memory performance in the self-initiated condition, particularly for related. We found a significant correlation between the effects of rTMS and strategy use, only in the self-initiated condition with related pairs. High strategy users showed reduced performance following DLPFC stimulation, while low strategy users tended to show increased recall following DLPFC stimulation during encoding. These results suggest the left DLPFC may be involved in the self-initiation of memory strategy use, and individuals may utilize different neural networks depending on their use of encoding strategies.</p> </div

Blinding integrity in randomized sham-controlled trials of repetitive transcranial magnetic stimulation for major depression : a systematic review and meta-analysis

Repetitive transcranial magnetic stimulation (rTMS) is a safe and effective treatment for major depression (MD). However, the perceived lack of a suitable sham rTMS condition might have compromised the success of blinding procedures in clinical trials. Thus, we conducted a systematic review and meta-analysis of randomized, double-blind and sham-controlled trials (RCTs) on high frequency (HF-), low frequency (LF-) and bilateral rTMS for MD. We searched the literature from January 1995 to July 2012 using Medline, EMBASE, PsycINFO, Cochrane Central Register of Controlled Trials and Scopus. The main outcome measure was participants' ability to correctly guess their treatment allocation at study end. We used a random-effects model and risk difference (RD). Overall, data were obtained from seven and two RCTs on HF- and bilateral rTMS, respectively. No RCT on LF-rTMS reporting on blinding success was found. HF- and bilateral rTMS trials enrolled 396 and 93 depressed subjects and offered an average of approximately 13 sessions. At study end, 52 and 59% of subjects receiving HF-rTMS and sham rTMS were able to correctly guess their treatment allocation, a non-significant difference (RD = -0.04; z = -0.51; p = 0.61). Furthermore, 63.3 and 57.5% of subjects receiving bilateral and sham rTMS were able to correctly guess their treatment allocation, also a non-significant difference (RD = 0.05; z = 0.49; p = 0.62). In addition, the use of angulation and sham coil in HF-rTMS trials produced similar results. In summary, existing sham rTMS interventions appear to result in acceptable levels of blinding regarding treatment allocation

Mean (and standard deviations) of responses given on the memory strategy questionnaire.

<div><p>Participants reported their strategy use on a 7 point scale, with 1 representing “never” and 7 representing “always”. The questions were:</p> <p>Q1. I considered how the words could be related to each other.</p> <p>Q2. I imagined the objects described by the words interacting in some way.</p> <p>Q3. I used prior personal memories associated with the objects.</p> <p>Q4. I constructed a sentence with the two words.</p> <p>Q5. I repeated the words to myself in my head.</p></div

Scatter plots for difference scores of TMS (DLPFC - vertex) in cued recall performance and mean elaborative strategy use (questions 1 to 4 on the questionnaire, with participants indicating a range of strategy use for each question from 1, “never”, to 7, “always”), across the four experimental task conditions.

<p>A positive difference score indicated that participants had increased performance following DLPFC stimulation (compared to vertex), while a negative score indicates DLPFC stimulation during encoding reduced later cued recall performance. A significant correlation was only found for the self-related condition, using Spearman’s Rho.</p