Depressão e câncer

Depression is the most common psychiatric disorder in patients with cancer, with prevalence rates ranging from 22% to 29%. This variability is associated to cancer sites, clinical stages, pain, limited physical functioning, beyond the existence of social support. Depression is associated to poorer prognosis and higher cancer mortality. Depressive syndromes can be a consequence of the antineoplasic therapies, as occurs in 21% to 58% of the patients treated with alfa-interferon. Sadness and desperation can inhibit the search for care by the patients, and difficult depression recognition. Antidepressant treatment is effective, and improve the adherence to cancer treatments, reducing side effects as nausea, pain and fatigue. In cancer patients, pretreatment with antidepressants seems to minimize depressive symptoms induced by interferon-alfa. Psychosocial interventions as relaxing techniques, group and individual psychotherapies can also be applied to reduce depressive and stress symptoms in patients with cancer.A depressão é o transtorno psiquiátrico mais comum em pacientes com câncer, com prevalências variando de 22% a 29%. Essa variabilidade está associada a sítios do tumor, estágio clínico, dor, funcionamento físico limitado, além da existência de suporte social. A depressão associa-se a um pior prognóstico e aumento da mortalidade pelo câncer. Síndromes depressivas podem ser uma consequência das terapias antineoplásicas, como ocorre em 21% a 58% dos pacientes recebendo interferon-alfa. Sentimentos de tristeza e desespero podem inibir a procura de cuidado pelos pacientes, dificultando o reconhecimento da depressão. O tratamento com antidepressivos é efetivo e melhora a adesão aos tratamentos do câncer, reduzindo efeitos adversos como náusea, dor e fadiga. Em pacientes com câncer, tratamento prévio com antidepressivos pode minimizar sintomas depressivos induzidos por interferon-alfa. O tratamento com antidepressivos parece ser uma estratégia efetiva para prevenir o desenvolvimento da depressão induzida por interferon-alfa. Intervenções psicossociais, como técnicas de relaxamento, terapia individual e em grupo, também podem ser utilizadas na redução dos sintomas depressivos e de estresse em pacientes com câncer

The schizophrenia stigma and mass media: a search for news published by wide circulation media in Brazil

CONTEXTO: O estigma que pesa sobre as doenças psiquiátricas é o mais forte impedimento para que o paciente busque tratamento, mais até que a dificuldade de acesso aos serviços de saúde. A esquizofrenia também é a doença mais usada hoje como metáfora na mídia, aparecendo rotineiramente associada a crimes e violência. OBJETIVOS: Avaliação da presença do estigma estrutural na mídia brasileira por meio do levantamento de notícias em imprensa e internet que utilizam o termo "esquizofrenia" e correlatos ("esquizofrênico/a") sob três aspectos: (a) uso médico e científico; (b) atribuição do diagnóstico de esquizofrenia a suspeitos de crimes com pouco ou nenhum rigor médico ou científico; (c) uso metafórico. MÉTODOS: O estudo foi realizado em três etapas: levantamento de notícias, classificação dos itens encontrados e análise do contexto em que foram publicados. O levantamento foi realizado em dois períodos - 2008 e 2011 -, sendo o primeiro restrito ao jornal Folha de S. Paulo e o segundo ampliado para os portais dos principais veículos impressos brasileiros. RESULTADOS: Foram encontrados 229 textos, distribuídos da seguinte forma: 89 (39%) registros em ciência e saúde, com tendência à impessoalidade; 62 (27%) registros em crime e violência, em que o "diagnóstico" de esquizofrenia é feito por leigos e "corroborado" por uma arqueologia da vida do suspeito que arrola toda sorte de comportamentos fora de padrão; 78 (34%) de uso metafórico, sempre de caráter depreciativo. CONCLUSÕES: A maioria dos textos encontrados (a) não dá voz ao portador de esquizofrenia e a seu sofrimento, (b) banaliza a doença psiquiátrica ao empregá-la fora de contexto para caracterizar decisões políticas e econômicas contraditórias ou de caráter duvidoso e (c) reforça o estigma que pesa sobre o portador de esquizofrenia ao personalizá-lo apenas nos raros casos de violência em que se supõe seu diagnóstico

A randomized clinical trial of home-based telepsychiatric outpatient care via videoconferencing: design, methodology, and implementation

Background Healthcare providers are continuously challenged to find innovative, cost-effective alternatives and to scale up existent services to meet the growing demand upon mental health care delivery. Due to continuous advances in technologies, telepsychiatry has become an effective tool for psychiatric care. In 2012, the Institute of Psychiatry of the University of São Paulo Medical School started a randomized clinical trial of home-based telepsychiatric outpatient care via videoconferencing. Objective The objective of this article is to describe the design, methodology and implementation of a pilot project, which aimed to verify the applicability and efficiency of psychiatric attendance via Internet-based videoconferencing in a resource-constrained environment. Methods The project consisted of a 12 months follow-up study with a randomized clinical trial, which compared various quality indicators between home-based telepsychiatric aftercare via videoconferencing and face-to-face aftercare. Results The final sample comprised 107 outpatients (53 in the telepsychiatry group and 54 in the control group). Among 1,227 realized consultations, 489 were held by videoconferencing. Satisfaction with the aftercare by videoconferencing and the medication delivery was high among patients. Attending psychiatrists were satisfied with the assistance by videoconferencing. Discussion The experiences during this pilot project have overall been very positive and psychiatric outpatient care by videoconferencing seems viable to treat patients even in a resource-constrained environment

Ansiedade na performance musical: tradução, adaptação e validação do Kenny Music Performance Anxiety Inventory (K-MPAI) para a língua portuguesa

BACKGROUND: Musical performance demands high-leveled coordination, concentration, motor- and memory-skills, making it particularly susceptible to anxiety states. Researches in this field have advanced significantly with the development of specific instruments to evaluate music performance anxiety, such as the Kenny Music Performance Anxiety Inventory (K-MPAI). OBJECTIVES: The present study has the objective of translating, adapting and validating the K-MPAI to the Portuguese language. METHODS: After the written consent given by the author of the original K-MPAI scale, the K-MPAI scale was translated and validated for Portuguese idiom. The Portuguese-version of K-MPAI was then applied to 218 amateur and professional musicians of both genders. For the concurrent validation, the validated Portuguese-version of the State Trait Anxiety Inventory (STAI) was used. RESULTS: Analysis of the internal consistency demonstrated a Cronbach's alpha = 0.957, with p < 0.001, replicated with p = 0.378 and the concurrent validation with the State Trait Anxiety Inventory, demonstrated a Cronbach's alpha = 0.642 and p < 0.001. DISCUSSION: The study allows evaluating data samples with high levels of reliability and replicability, which translates this study based on an unbiased sample and replicable to other populations. The concurrent validation between K-MPAI and IDATE, allows inferring that the scales are comparable in their capability of measuring anxiety levels in musicians.CONTEXTO: A performance musical requer alto nível de habilidade em diversos parâmetros, como coordenação motora, atenção e memória, o que a torna particularmente suscetível aos estados de ansiedade. Pesquisas nessa área têm avançado com a introdução de instrumentos específicos para abordar a ansiedade na performance musical, como é o caso da Kenny Music Performance Anxiety Inventory (K-MPAI). OBJETIVOS: O presente estudo teve como objetivo traduzir, adaptar e validar a K-MPAI para a língua portuguesa. MÉTODOS: Após autorização da autora, a escala K-MPAI foi traduzida e validada. A escala em língua portuguesa foi aplicada a 218 músicos de ambos os sexos, amadores e profissionais. Para a validação concorrente, foi utilizado o Inventário de Ansiedade Traço-Estado (IDATE), versão validada na língua portuguesa da State Trait Anxiety Inventory (STAI). RESULTADOS: A análise da consistência interna apresentou alfa de Cronbach = 0,957 com p < 0,001, reprodutibilidade com p = 0,378 e validação concorrente com a IDATE com alfa de Cronbach = 0,642 e p < 0,001. CONCLUSÃO: O estudo permite considerar a amostra com graus de confiabilidade e reprodutibilidade elevados, o que traduz este estudo como provindo de uma amostra não tendenciada e replicável a outras populações. A validação concorrente entre a K-MPAI e a IDATE permite inferir que ambas as escalas são comparáveis na capacidade de medir os níveis de ansiedade em musicistas

Addressing Mood Disorder Diagnosis' Stigma With an Honest, Open, Proud (HOP)-Based Intervention: A Randomized Controlled Trial

Introduction: The public stigma and self-stigma contribute to the dilemma of disclosing or not one's own mental illness diagnosis. Studies suggest that revealing it diminishes stress, besides helping with self-esteem. Honest, Open, Proud (HOP) is a group program that aids in the process of deciding on it, reducing its impact. Considering the relevance of this issue, the present study aimed to apply a HOP-based intervention in a group of patients diagnosed with mood disorders. Methods: A randomized controlled clinical trial was used, including 61 patients with mood disorders, of whom 31 were diagnosed with depression and 30 were diagnosed with bipolar disorder. They were randomly placed on the intervention (HOP) or the control group (unstructured psychoeducation). The evaluations occurred before (T0) and after (T1) the sessions. We administered eight scales, from which three presented relevant results: Coming Out with Mental Illness Scale (COMIS), Cognitive Appraisal of Stigma as a Stressor (CogApp), and Authenticity Scale. Results: The intervention groups (depression and bipolar) did not present a significant change regarding the decision to disclose their diagnostics. However, the depression group showed a decrease on the perception of stigma as a stressor (T0 = 0.50 vs. T1 = -1.45; p = 0.058). Improvements in post-intervention results were seen for both groups (depression and bipolar) on the Authenticity Scale-self-alienation subscale (T0 = 10.40 vs. T1 = 12.37, p = 0.058). Conclusion: Our HOP-based intervention appeared to be an important program to aid patients in facing stigma stress, showing positive effects, whether helping to diminish stress or to improve self-conscience, both of which have indirect effects on self-stigma. As it is a compact program, it can bring benefits when applying to public health institutions

Benefits of psychodynamic group therapy on depression, burden and quality of life of family caregivers to Alzheimer’s disease patients

Abstract Background Family members providing continuous care to demented patients suffer from severe burden that impairs quality of life and often evolves to depression. Objective This study aims to evaluate the effect of psychodynamic group psychotherapy (PGT) compared to body awareness therapy (BAT) on caregiver burden, depressive symptoms, and quality of life among family caregivers to Alzheimer disease (AD) patients. Methods Thirty-seven healthy family caregivers were randomly allocated to receive PGT (n = 20) or BAT (n = 17). Interventions were administered in the format of 14 weekly group sessions. Outcome measures were: modification of scores on Zarit Burden Scale, Beck Depression Inventory and WHO-QoL Scale. Results Participants in the PGT group displayed significant reduction on burden (p = 0.01) and depression scores (p = 0.005), and improved quality of life (p = 0.002), whereas those in the BAT group showed improvements in burden of care (p = 0.001) and quality of life (p = 0.01), but not on depressive symptoms (p = 0.13). Discussion Psychodynamic psychotherapy was associated with amelioration of depressive symptoms, but overall benefits on burden of care and quality of life were similar irrespective of the type of intervention, i.e., psychologically-oriented or not. We hypothesize that these interventions can be complementary to improve depression and burden of care among family caregivers of AD patients

Carbon nanotubes applied in neuroscience: prospects and challenges

INTRODUÇÃO: Os nanotubos de carbono (NTCs) são os nanomateriais mais promissores para aplicação terapêutica em doenças neurodegenerativas. Aplicações potenciais incluem sistemas de liberação controlada de fármacos, interfaces elétricas e substratos para crescimento celular. OBJETIVO: Descrever o estado da arte e as perspectivas e desafios da aplicação dos NTCs nas neurociências. MÉTODO: Procedeu-se a uma busca sistemática nos indexadores Medline, Lilacs e SciELO, utilizando os descritores "carbon nanotubes", "drug delivery", "electrical interface", "tissue regeneration", "neuroscience", "biocompatibility" e "nanotechnology", devidamente agrupados. RESULTADOS: A revisão da literatura evidenciou controvérsias nos estudos relativos à biocompatibilidade dos NTCs, embora tenha ratificado o seu potencial para a neuromedicina e neurociências. CONCLUSÃO: Os dados obtidos apontam a necessidade de estudos padronizados sobre as aplicações e interações dessas nanoestruturas com os sistemas biológicos.BACKGROUND: Carbon nanotubes (CNTs) are the most promising nanomaterials for therapeutic application in neurodegenerative diseases. Potential applications include systems for controlled drug delivery, electrical interfaces and substrates for cell growth. OBJECTIVE: To describe the state of art, prospects and challenges of applying CNTs in neuroscience. METHODS: There has been systematic search in Medline, Lilacs and SciELO, using the keywords "carbon nanotubes", "drug delivery", "electrical interface", "tissue regeneration", "neuroscience", "nanotechnology" and "biocompatibility", properly grouped. RESULTS: The literature review showed controversies in studies on the biocompatibility of CNTs, although it has ratified its potential for neuromedicine and neuroscience. DISCUSSION: These results highlight the need for modeling studies on the applications and interactions of nanostructures with biological systems

Stigma toward schizophrenia : do all psychiatrists behave the same? Latent profile analysis of a national sample of psychiatrists in Brazil

Background: An important issue concerning the worldwide fight against stigma is the evaluation of psychiatrists’ beliefs and attitudes toward schizophrenia and mental illness in general. However, there is as yet no consensus on this matter in the literature, and results vary according to the stigma dimension assessed and to the cultural background of the sample. The aim of this investigation was to search for profiles of stigmatizing beliefs related to schizophrenia in a national sample of psychiatrists in Brazil. Methods: A sample of 1414 psychiatrists were recruited from among those attending the 2009 Brazilian Congress of Psychiatry. A questionnaire was applied in face-to-face interviews. The questionnaire addressed four stigma dimensions, all in reference to individuals with schizophrenia: stereotypes, restrictions, perceived prejudice and social distance. Stigma item scores were included in latent profile analyses; the resulting profiles were entered into multinomial logistic regression models with sociodemographics, in order to identify significant correlates. Results: Three profiles were identified. The “no stigma” subjects (n = 337) characterized individuals with schizophrenia in a positive light, disagreed with restrictions, and displayed a low level of social distance. The “unobtrusive stigma” subjects (n = 471) were significantly younger and displayed the lowest level of social distance, although most of them agreed with involuntary admission and demonstrated a high level of perceived prejudice. The “great stigma” subjects (n = 606) negatively stereotyped individuals with schizophrenia, agreed with restrictions and scored the highest on the perceived prejudice and social distance dimensions. In comparison with the first two profiles, this last profile comprised a significantly larger number of individuals who were in frequent contact with a family member suffering from a psychiatric disorder, as well as comprising more individuals who had no such family member. Conclusions: Our study not only provides additional data related to an under-researched area but also reveals that psychiatrists are a heterogeneous group regarding stigma toward schizophrenia. The presence of different stigma profiles should be evaluated in further studies; this could enable anti-stigma initiatives to be specifically designed to effectively target the stigmatizing group