Updates and current perspectives of psychiatric assessments after traumatic brain injury: a systematic review

Neuropsychological and psychiatric disorders represent a major concern and cause of disabilities after the trauma, contributing to worse recovery after traumatic brain injury (TBI). However, the lack of well-defined parameters to evaluate patient's psychiatric disorders leads to a wide range of diagnoses and symptoms. The aim of this study was to perform a review of literature in order to gather data of the most common scales and inventories used to assess and diagnose depression, anxiety, and posttraumatic stress disorder (PTSD) after TBI. We conducted a literature search via MEDLINE, PubMed, and Web of Science. We included reviews, systematic reviews, and meta-analysis studies, and we used the following keywords: "traumatic brain injury OR TBI," "depression OR depressive disorder," "anxiety," and "posttraumatic stress disorder OR PTSD." From 610 titles, a total of 68 systematic reviews or meta-analysis were included in the section "Results" of this review: depression (n = 32), anxiety (n = 9), and PTSD (n = 27). Depression after TBI is a more established condition, with more homogeneous studies. Anxiety and PTSD disorders have been studied in a heterogeneous way, usually as comorbidity with other psychiatric disorders. Some scales and inventories designed for the general community may not be appropriate for patients with TBI7CONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICO - CNPQ201809/2014-

Depression during pregnancy in women with a medical disorder: risk factors and perinatal outcomes

BACKGROUND: Approximately one-fifth of women present depression during pregnancy and puerperium, and almost 13% of pregnant women experience a major depressive disorder. OBJECTIVE: The aim of this study was to identify risk factors for depression among pregnant women with a medical disorder and to evaluate the influence of depression on perinatal outcomes. METHODS: Three hundred and twenty-six pregnant women with a medical disorder were interviewed. A semistructured interview was conducted for each participant using a questionnaire that had been developed previously. Major depression was diagnosed using the Portuguese version of the Primary Care Evaluation of Mental Disorders (PRIME-MD). The medical records of the participants were thoroughly reviewed to evaluate the perinatal results. RESULTS: Major depressive disorder was diagnosed in 29 cases (9.0%). The prevalence of major depression was as follows: 7.1% for preeclampsia or chronic hypertension, 12.1% for cardiac disorder, 7.1% for diabetes mellitus, 6.3% for maternal anemia, 8.3% for collagenosis and 12.5% for a high risk of premature delivery. An univariate analysis showed a significant positive correlation between an average household income below minimum wage and a PRIME-MD diagnosis of major depression. A multiple regression analysis identified unplanned pregnancy as an independent predictor of major depression (86.2% in the group with a diagnosis of major depression by PRIME-MD vs. 68.4% in the group without major depression). A comparison between women who presented major depression and those who did not revealed no significant differences in the perinatal results (i.e., preterm delivery, birth weight and low Apgar scores). CONCLUSION: In the present study, unplanned pregnancy in women with a medical disorder was identified as a risk factor for major depression during gestation. Major depression during pregnancy in women with a medical disorder should be routinely investigated using specific methods

Recognition of Depressive Symptoms by Physicians

OBJECTIVE: To investigate the recognition of depressive symptoms of major depressive disorder (MDD) by general practitioners. INTRODUCTION: MDD is underdiagnosed in medical settings, possibly because of difficulties in the recognition of specific depressive symptoms. METHODS: A cross-sectional study of 316 outpatients at their first visit to a teaching general hospital. We evaluated the performance of 19 general practitioners using Primary Care Evaluation of Mental Disorders (PRIME-MD) to detect depressive symptoms and compared them to 11 psychiatrists using Structured Clinical Interview Axis I Disorders, Patient Version (SCID I/P). We measured likelihood ratios, sensitivity, specificity, and false positive and false negative frequencies. RESULTS: The lowest positive likelihood ratios were for psychomotor agitation/retardation (1.6) and fatigue (1.7), mostly because of a high rate of false positive results. The highest positive likelihood ratio was found for thoughts of suicide (8.5). The lowest sensitivity, 61.8%, was found for impaired concentration. The sensitivity for worthlessness or guilt in patients with medical illness was 67.2% (95% CI, 57.4–76.9%), which is significantly lower than that found in patients without medical illness, 91.3% (95% CI, 83.2–99.4%). DISCUSSION: Less adequately identified depressive symptoms were both psychological and somatic in nature. The presence of a medical illness may decrease the sensitivity of recognizing specific depressive symptoms. CONCLUSIONS: Programs for training physicians in the use of diagnostic tools should consider their performance in recognizing specific depressive symptoms. Such procedures could allow for the development of specific training to aid in the detection of the most misrecognized depressive symptoms

The association of major depressive episode and personality traits in patients with fibromyalgia

INTRODUCTION: Personality traits have been associated with primary depression. However, it is not known whether this association takes place in the case of depression comorbid with fibromyalgia. OBJECTIVE: The authors investigated the association between a current major depressive episode and temperament traits (e.g., harm avoidance). METHOD: A sample of 69 adult female patients with fibromyalgia was assessed with the Temperament and Character Inventory. Psychiatric diagnoses were assessed with the Mini-International Neuropsychiatric Interview severity of depressive symptomatology with the Beck Depression Inventory, and anxiety symptomatology with the IDATE-state and pain intensity with a visual analog scale. RESULTS: A current major depressive episode was diagnosed in 28 (40.5%) of the patients. They presented higher levels of harm avoidance and lower levels of cooperativeness and self-directedness compared with non-depressed patients, which is consistent with the Temperament and Character Inventory profile of subjects with primary depression. However, in contrast to previous results in primary depression, no association between a major depressive episode and self-transcendence was found. CONCLUSIONS: The results highlight specific features of depression in fibromyalgia subjects and may prove important for enhancing the diagnosis and prognosis of depression in fibromyalgia patients

Perception influence of professionals regarding unsafe in attention to women's health

OBJETIVO: Identificar o conhecimento e a percepção dos profissionais da saúde em relação à legislação brasileira sobre o aborto provocado. MÉTODOS: Envelopes selados não identificados contendo os questionários foram enviados a todos os profissionais (n=149) que trabalham no Departamento de Obstetrícia de hospital universitário e de hospital público da periferia de São Paulo. Responderam ao questionário 119 profissionais. Para análise dos dados, utilizou-se intervalo de confiança de 0,05 e os testes exatos de Fischer e χ². RESULTADOS: Dos profissionais entrevistados, 48,7% eram médicos, 33,6% profissionais da área de enfermagem e 17,6% eram profissionais de outras áreas (psicólogos, nutricionistas, fisioterapeutas, administrativos e técnicos de laboratórios). Constatou-se diferença significativa (p=0,01) na proporção de profissionais que acreditam que o aborto por malformação fetal não letal e no aborto decorrente de gestações não planejadas deveriam ser incluídos na legislação brasileira. Observou-se que o conhecimento da legislação e da descrição das situações permitidas por lei acerca do aborto foi significativamente diferente na comparação entre os profissionais de saúde (p=0,01). Quando questionados sobre as situações em que a legislação brasileira permite o aborto, observou-se que 32,7% dos médicos, 97,5% profissionais da área de enfermagem e 90,5% dos demais profissionais desconhecem a legislação vigente. CONCLUSÃO: Neste estudo, evidenciou-se o desconhecimento dos profissionais de saúde com relação à legislação brasileira, em menor proporção entre obstetras e em maior proporção entre os profissionais da área de enfermagem. Foram constatadas atitudes de discriminação, julgamento e preconceito na assistência prestada às mulheres que provocam o aborto

Color Trails Test: a Brazilian normative sample

The present study aims to evaluate psychometric data on the population of Brazil using of the Color Trails Test (CTT). The instrument was applied to 1,942 subjects who came from the north (1.4%), northeast (10.4%), midwest (7.7%), southeast (65.9%), and south (13.9%) regions of Brazil. Ages varied from 18 to 86 years (M = 40.03 years; DP = 16.02), with 386 males (19.9%) and 1,556 females (80.1%). Regarding schooling, 57 (3%) of participants were illiterate, 1.240 (64%) had primary education and 645 (33%) had a high school and/or superior diploma. The length of schooling ranged from 0 to 14 (M = 7.81, SD = 3.51) years. Good accuracy ratings were obtained using Spearman's coefficient on the main measures of the CTT, including time of execution form 1 (0.76) and form 2 (0.82). Regional variations showed that the northeast region had the worst results on the instrument. Males had better performance on the proposed task, with significant differences between age groups and the worst results for ages greater than 60 years. For both sexes, an increase in score was noticed with increasing age, and better performance was found with increasing levels of education. The present results suggest that the CTT can identify attentional disturbances with significant variations in the time of execution

A vivência da amamentação em “mães de primeira viagem”

L'allaitement dépasse la limite du biologique, en nous insérant aussi de contextes social et psychologique. Cette étude, réalisée à la Clinique Obstétrique de ICHC-FMUSP, a utilisé la méthodologie qualitative pour interviewer en profondeur dix « mères de premier voyage », afin de comprendre des aspects psychologiques impliqués dans l'allaitement, dans la première semaine de vie du bébé, et comme ces mères traitent avec les orientations des arrivées de l'équipe de santé. Des entrevues individuelles et de l'analyse qualitative des données ont été réalisées. L'allaitement est apparu comme une expérience ambivalente, avec des sentiments de pouvoir et complétude, de féminité, mais aussi une expérience pénible. La moitié des interviewées a reçu des orientations de l'équipe de santé, senties comme une aide et une sécurité émotionnelle. Ainsi, l'allaitement, quand il n'est pas imposé, peut favoriser la rencontre de la mère avec son bébé et le contact avec elle-même. L'équipe de santé peut agir comme une facilitation, en utilisant des connaissances techniques mais en se maintenant ouverte à l'écoute de ces femmes.A amamentação ultrapassa o limite do biológico, inserindo-se também nos âmbitos social e psicológico. Esse estudo, realizado na Clínica Obstétrica do ICHC-FMUSP, utilizou a metodologia qualitativa para entrevistar em profundidade dez "mães de primeira viagem", a fim de compreender aspectos psicológicos envolvidos na amamentação, na primeira semana de vida do bebê, e como essas mães lidam com as orientações vindas da equipe de saúde. Foram realizadas entrevistas individuais e análise qualitativa dos dados. A amamentação apareceu como uma vivência ambivalente, com sentimentos de poder e completude, feminilidade, mas também uma experiência dolorosa. Metade das entrevistadas recebeu orientações da equipe de saúde, sentidas como um apoio e segurança emocional. Assim, a amamentação, quando não é imposta, pode favorecer o encontro da mãe com seu bebê e o contato com ela mesma. A equipe de saúde pode atuar como facilitadora, utilizando conhecimentos técnicos, mas mantendo-se aberta à escuta dessas mulheres.El amamantamiento sobrepasa el límite biológico, haciendo parte también de los ámbitos social y psicológico. Este estudio, realizado en la Clínica Obstétrica del ICHC-FMUSP, utilizó la metodología cualitativa para entrevistar con detenimiento a diez "madres de primer viaje", con la finalidad de comprender aspectos psicológicos vinculados al amamantamiento en la primera semana de vida del bebé, y cómo esas madres manejan las orientaciones recibidas del equipo de salud. Fueron realizadas entrevistas individuales y análisis cualitativo de los datos. El amamantamiento apareció como una experiencia ambivalente, con sentimientos de poder y sensación de plenitud, femineidad, pero también una experiencia dolorosa. La mitad de las entrevistadas recibió orientaciones del equipo de salud, las cuales fueron evaluadas como un apoyo y seguridad emocional. Así, el amamantamiento, cuando no es impuesto, puede favorecer el encuentro de la madre con su bebé y el contacto con ella misma. El equipo de salud puede actuar como facilitador, utilizando conocimientos técnicos pero manteniéndose de oídos abiertos hacia esas mujeres.Breast-feeding exceeds the boundaries of biology, inserting itself also in the social and psychological scopes. This study, taken place in the Obstetric Clinic of the ICHC-FMUSP, used the qualitative methodology to interview in depth ten "first-time mothers", in order to understand the psychological aspects involved in breast-feeding, during the baby’s first week of life, and how these mothers dealt with the guidance given by the health team. Individual interviews and qualitative analysis of the data has been carried through. Breast-feeding appeared as an ambivalent experience, with feelings of power and completeness, femininity, but also appeared as a painful experience. Half of the interviewed mothers received guidance from the health team, and felt it as an emotional support and security. Thus, breast-feeding, when it is not imposed, may favor the meeting of mother and child, as well as the contact of the mother with herself. The health team can act as a facilitator, using technical knowledge, but always keeping themselves opened to listening to these women

Estresse em Pacientes com Glaucoma Primário de Ângulo Aberto

Primary Open-Angle Glaucoma (POAG) is an important cause of blindness worldwide. This paper aimed to investigate: (a) the presence and type of stress; (b) the relationship between the number of eye-drops and stress; (c) perceptions regarding glaucoma and its treatment. In a transversal and quantitative study, we assessed 102 patients from the Ophthalmology Clinic of the HC-FMUSP by means of a thematic interview and the Lipp’s Stress Symptoms Inventory (LSSI). Most of the patients were stressed (65,7%) and there was no correlation between stress and the number of eye-drops. “Time of treatment”, “difficulties in daily life” and “difficulties to instillate the drops” were independently associated with stress. In conclusion, stress can negatively interfere in coping with POAG.  Glaucoma Primário de Ângulo Aberto (GPAA) é uma importante causa de cegueira no mundo. O presente trabalho teve como objetivo investigar: (1) presença e tipo de estresse; (2) relação do número de colírios e estresse; (3) percepção do glaucoma e tratamento. Um estudo transversal e quantitativo foi realizado com 102 pacientes do Ambulatório de Oftalmologia do HC-FMUSP, com roteiro temático e Inventário de Sintomas de Estresse de Lipp. A maioria dos pacientes apresentou estresse (65,7%) e não houve correlação entre estresse e número de colírios. “Tempo de tratamento”, “dificuldades na vida diária” e “dificuldades em pingar o colírio” foram variáveis independentemente associadas ao estresse. Conclui-se que o estresse pode interferir negativamente no enfrentamento da doença em pacientes com GPAA. &nbsp

Perfil sociodemográfico, eventos de vida e características afetivas de pacientes com insuficiência renal crônica em tratamento por hemodiálise e diálise peritoneal: um estudo descritivo

The Chronic Renal Insufficiency (CRI) causes physical and psychological limitations to patients, leading to feelings of impotence and helplessness, and consequently to the emergency of several disorders and psychological difficulties. This study aimed to describe sociodemografic profile, events of life and affective characteristics of patients with chronic insufficience renal in treatment for hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD). Thirty patients in treatment for more than six months were included in the study, of which 15 were in treatment with HD and 15 with CAPD. The Social Readjustment Rating Scale (SRRS), a semi-directed interview and the Hospital Anxiety and Depression Scale (HADS) were used as instruments for evaluation. It was verified that the patients in HD possess greater probability to develop other problems of health (74%) and greater anxiety indices (47%). On the other hand, the patients in treatment for CAPD had presented greater depression incidence (47%).  A Insuficiência Renal Crônica (IRC) acarreta aos pacientes limitações físicas e psicológicas, o que provoca sentimentos de impotência e abandono, suscitando a emergência de diversas desordens e dificuldades psicológicas. O presente estudo teve como objetivos apresentar o perfil sociodemográfico, eventos de vida e características afetivas de pacientes com insuficiência renal crônica em tratamento por hemodiálise (HD) e diálise peritoneal ambulatorial contínua (CAPD). Foram incluídos neste estudo 30 sujeitos em tratamento, há mais de seis meses, sendo 15 sujeitos em tratamento por HD e 15 por CAPD. Como instrumentos, utilizaram-se: entrevista semidirigida, Escala de Avaliação do Reajustamento Social (EARS) e Escala de Ansiedade e Depressão Hospitalar (HADS). Verificou-se que os pacientes em HD possuem maior probabilidade de desenvolver outros problemas de saúde (74%) e maiores índices de ansiedade (47%). Em contrapartida, os pacientes em tratamento por CAPD apresentaram maior incidência de depressão (47%).