Validade do diagnóstico de transtorno de estresse pós-traumático do Composite International Diagnostic Interview (CIDI 2.1) de acordo com os critérios diagnósticos da DSM-IV

The objective was to study the accuracy of the post-traumatic stress disorder (PTSD) section of the Composite International Diagnostic Interview (CIDI 2.1) DSM-IV diagnosis, using the Structured Clinical Interview (SCID) as gold standard, and compare the ICD-10 and DSM IV classifications for PTSD. The CIDI was applied by trained lay interviewers and the SCID by a psychologist. The subjects were selected from a community and an outpatient program. A total of 67 subjects completed both assessments. Kappa coefficients for the ICD-10 and the DSM IV compared to the SCID diagnosis were 0.67 and 0.46 respectively. Validity for the DSM IV diagnosis was: sensitivity (51.5%), specificity (94.1%), positive predictive value (9.5%), negative predictive value (66.7%), misclassification rate (26.9%). The CIDI 2.1 demonstrated low validity coefficients for the diagnosis of PTSD using DSM IV criteria when compared to the SCID. The main source of discordance in this study was found to be the high probability of false-negative cases with regards to distress and impairment as well as to avoidance symptoms.O objetivo deste artigo foi estudar a validade concorrente da seção de transtorno de estresse pós-traumático do CIDI 2.1 critérios DSM IV, utilizando o Structured Clinical Interview (SCID) como padrão-ouro, e comparar o diagnóstico de TEPT entre CID-10 e DSM IV. O CIDI foi aplicado por entrevistadores leigos treinados e o SCID por uma psicóloga. A amostra foi composta por sujeitos da comunidade e de um ambulatório de especialidade psiquiátrica. Sessenta e sete sujeitos completaram ambos os questionários. O coeficiente kappa foi de 0.46 ao comparar DSM IV com a SCID. A validade diagnóstica usando critérios do DSM IV foi de: sensibilidade = 51.5%, especificidade = 94.1%, valor preditivo positivo = 89.5%, valor preditivo negativo = 66.7%, taxa de classificação incorreta = 26.9%. O CIDI 2.1 apresentou valores baixos para os coeficientes de validação de TEPT usando os critérios do DSM IV ao comparar com o SCID. A principal causa de discordância foi o grande número de casos falsos negativos devido aos sintomas de significância clínica e sintomas de evitação.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Universidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaUNIFESP, EPMSciEL

Cyberbullying and adolescent mental health: systematic review

Cyberbullying is a new form of violence that is expressed through electronic media and has given rise to concern for parents, educators and researchers. in this paper, an association between cyberbullying and adolescent mental health will be assessed through a systematic review of two databases: PubMed and Virtual Health Library (BVS). the prevalence of cyberbullying ranged from 6.5% to 35.4%. Previous or current experiences of traditional bullying were associated with victims and perpetrators of cyberbullying. Daily use of three or more hours of Internet, web camera, text messages, posting personal information and harassing others online were associated with cyberbullying. Cybervictims and cyberbullies had more emotional and psychosomatic problems, social difficulties and did not feel safe and cared for in school. Cyberbullying was associated with moderate to severe depressive symptoms, substance use, ideation and suicide attempts. Health professionals should be aware of the violent nature of interactions occurring in the virtual environment and its harm to the mental health of adolescents.Department of Psychiatry at the Federal University of São PauloAcademic League for Violence Prevention and Intervention (LAPIV)Universidade Federal de São Paulo, BR-05414012 São Paulo, BrazilUniv São Paulo, São Paulo, BrazilUniversidade Federal de São Paulo, BR-05414012 São Paulo, BrazilWeb of Scienc

Aspectos gerais da COVID-19 e suas consequências

Introdução: Em dezembro de 2019, foram relatados na cidade de Wuhan, China, vários casos de pneumonia de etiologia desconhecida. A doença denominada COVID­19 tornou­se uma pandemia. O novo vírus foi nomeado SARS­CoV­2. Justificativa: Importante para compreender melhor como o vírus age no organismo e a gravidade da doença. Objetivo: Descrever as consequências da COVID­19, abordando aspectos gerais da infecção por SARS­CoV­2 e seu acometimento sistêmico. Material e métodos: Foi feita uma revisão narrativa da literatura e foram selecionados 50 artigos de interesse, sendo 16 descartados e 34 compuseram este trabalho. As bases de dados utilizadas foram Pubmed, Scielo, Google Scholar e Organização Mundial da Saúde (OMS). Resultados: SARS­CoV­2 é um RNA vírus, envelopado, pertencente ao gênero β-CoV. Através da proteína de pico S (Spike), SARS­CoV­2, anexa­se às células humanas através do receptor da enzima conversora de angiotensina­2 (ECA2). A transmissão do SARS­CoV­2 de pessoa a pessoa ocorre por meio de auto inoculação nas mucosas (nariz, olhos ou boca) e contato com superfícies inanimadas contaminadas. Seus sintomas incluem desde manifestações em estágios mais leves ou de modo mais grave, como febre, fadiga, tosse seca, mialgia, insuficiência respiratória e até mesmo a morte. Pessoas idosas e com comorbidades são consideradas grupo de risco e merecem especial atenção. Discussão: O acometimento de vários órgãos pelo SARS­CoV­2 tem sido associado à ampla distribuição da ECA2 no corpo. No pulmão, pneumonia parece ser a manifestação mais grave da infecção por SARS­CoV­2. No coração, níveis elevados de troponina evidenciam lesão cardíaca. No rim, ECA2 é expressa em várias células e lesão renal aguda é a complicação mais frequente. No fígado, lesão hepática aguda e anormalidades em enzimas hepáticas foram relatadas. O acometimento neurológico é decorrente de múltiplas vias fisiopatológicas. No trato gastrointestinal (TGI), atenção especial é necessária, pois as manifestações podem preceder a apresentação respiratória típica. Conclusão: A presença da ECA2 no organismo é fundamental para o vírus SARS­CoV­2. Além do pulmão, outros órgãos também são afetados pela infecção. Palavras chaves: pandemia, COVID­19, virologia, sintomas, comorbidades, complicações.Introduction: In December 2019, several cases of pneumonia of unknown etiology were reported in the city of Wuhan, China. The disease called COVID­19 has become a pandemic. The new virus was named SARS­CoV­2. Justification: Important to better understand how the virus acts in the body and the severity of the disease. Objective: To describe the consequences of COVID­19, considering general aspects of SARS­CoV­2 infection and its systemic involvement. Material and Methods: A narrative review of the literature was carried out and 50 articles of interest were selected, 16 of which were discarded and 34 composed this work. The databases used were Pubmed, Scielo, Google Scholar and the World Health Organization (WHO). Results: SARS-CoV-2 is an enveloped RNA virus belonging to the β-CoV genus. Through the S peak protein (Spike), SARS­CoV­2 attaches itself to human cells through the angiotensin­2 converting enzyme receptor (ACE2). The transmission of SARS­CoV­2 from person to person occurs through self­inoculation in the mucous membranes (nose, eyes or mouth) and contact with contaminated inanimate surfaces. Its symptoms range from milder or more severe manifestations, such as fever, fatigue, dry cough, myalgia, respiratory failure, and even death. Elderly people with comorbidities are considered a risk group and deserve special attention. Discussion: The involvement of several organs by SARS­CoV­2 has been associated with the wide distribution of ACE2 in the body. In the lung, pneumonia appears to be the most serious manifestation of SARS­CoV­2 infection. In the heart, elevated levels of troponin evidence cardiac injury. In the kidney, ACE2 is expressed in several cells and acute kidney injury is the most frequent complication. In the liver, acute liver damage and abnormalities in liver enzymes have been reported. Neurological involvement is due to multiple pathophysiological pathways. In the gastrointestinal tract (GI tract), special attention is needed, as the manifestations may precede the typical respiratory presentation. Conclusion: The presence of ACE2 in the body is essential for the SARS­CoV­2 virus and in addition to the lung, other organs are also affected by the infection. Key words: pandemic, COVID­19, virology symptoms, comorbidities, complications.Não recebi financiament

Epidemiology of Psychotropic Drug Use in Rio de Janeiro, Brazil: Gaps in Mental Illness Treatments

Objective: Estimate the prevalence of psychotropic drugs use in the city of Rio de Janeiro, Brazil, and establish its relationship with the presence of mental disorders.Methods: A probabilistic sample of non-institutionalized individuals, from the general population of Rio de Janeiro (n = 1208; turn out:81%), 15 years or older, who were interviewed using the Composite International Diagnostic Interview 2.1 (depression, anxiety-phobia, OCD\PTSD, alcoholism sections), and asked about their psychotropic use during a 12 and one-month period before the interview. Data were collected between June/2007-February/2008. the prevalence was estimated with a confidence interval of 95%. the associations between psychotropics use and mental disorders were analyzed through a logistic regression model (Odds Ration - OR).Results: the one-month prevalence of psychotropic drug use was 6.55%, 3.19% for men and 9.13% for women. Antidepressants were the most frequently used drug (2.78%), followed by anorectics (1.65%), tranquilizers (1.61%) and mood stabilizers (1.23%). General practitioners issued the highest number of prescriptions (46.3%), followed by psychiatrists (29.3%); 86.6% of the psychotropic drugs used were paid for by the patient himself. Individuals with increased likelihood of using psychotropic drugs were those that had received a psychiatric diagnosis during a one-month period before the study (OR:3.93), females (OR:1.82), separated/divorced (OR:2.23), of increased age (OR:1.03), with higher income (OR:2.96), and family history of mental disorder (OR:2.59); only 16% of the individuals with a current DSM IV diagnosis were using a psychotropic drug; 17% among individuals with a depression-related diagnosis and 8% with Phobic Anxiety Disorders-related diagnosis used psychotropics.Conclusion: Approximately 84% of individuals displaying some mental disorder did not use psychotropic drugs, which indicates an important gap between demand and access to treatment. A significant failure is evident in the health system for patients with mental disorders; this could be due to health workers' inability to recognize mental disorders among individuals