Alfredo Cataldo Neto

Sono e envelhecimento

OBJETIVO: descrever aspectos atualizados sobre as alteracoes e os disturbios do sono no processo de envelhecimento normal e usual. METODOS: procedeu-se a revisao da arquitetura do sono e ritmo circadiano de sono e vigilia para estabelecer o padrao de normalidade e as alteracoes fisiologicas no processo de envelhecimento, descrevendo-se os disturbios de sono mais prevalentes no idoso, sua avaliacao diagnostica e o manejo nao-farmacologico. O texto foi elaborado a partir da consulta as publicacoes cientificas indexadas no Medline, em outras de acesso on line e em livros textos das areas de geriatria, psiquiatria geriatrica e medicina do sono. RESULTADOS E CONCLUSAO: a maioria dos idosos tem queixas relacionadas ao sono decorrentes de mudancas fisiologicas especificas do processo de envelhecimento ou de doencas que podem causar disturbios secundarios de sono. A linha divisoria entre a normalidade e o disturbio pode ser estabelecida por meio de criteriosa avaliacao diagnostica, a qual necessariamente precede e orienta a conduta terapeutica. A maioria dos disturbios de sono sao clinicamente importantes e trataveis com medidas nao-farmacologicas, que incluem a orientacao sobre rotinas e rituais de sono, atividades de vida diaria e condicoes ambientais.AIM: to describe the up-to-date aspects on sleep changes and disturbances in the normal and usual aging process. METHODS: the sleep architecture and the sleep and vigil circadian rhythm were reviewed in order to establish the normalcy pattern and physiological changes in the aging process, describing the most prevalent sleep disturbances of the elderly, their diagnostic evaluation and non-pharmacological management. The text was drawn up based on consulting scientific publications indexed in Medline, in other on-line access publications and in textbooks in the fields of geriatrics, geriatric psychiatry and sleep therapy. RESULTS AND CONCLUSION: Most of the elderly have sleep-related complaints resulting from specific physiological changes that are specific to the aging process or to diseases that may cause secondary sleep disturbances. The borderline between normalcy and disturbance may be established by means of a judicious diagnostic evaluation that necessarily precedes and guides the therapeutic management. Most sleep disturbances are clinically significant and can be treated with non-pharmacological measures, which include guidance concerning sleep routines and rituals, everyday life activities and environmental conditions.

Suicide risk in the elderly: Data from Brazilian public health care program

OBJECTIVE Examine prevalence and level of suicide risk, and its associations with sociodemographic factors and mood disorders. METHODS A cross-sectional study with a random sample of 530 individuals aged 60 years or more from Family Health Strategy of Porto Alegre, Brazil. Diagnosis was made by psychiatrists using the Mini International Neuropsychiatric Interview plus (MINIplus). RESULTS Suicide risk was found in 15.7% of the sample. Female gender, elderly with no income or with no paid activity and those who have lost one or more of his sons presented association with suicide risk. Bipolar disorder shows association with suicide risk for those with or without current episode. For unipolar depression only elderly with a current episode shows association with suicide risk. LIMITATIONS The cross-sectional design limits the examination of causative relationships. The MINIplus questions are not broad enough to assess other important self-destructive behaviors. CONCLUSIONS A high rate of suicide risk was found. As expected an increased rate of mood disorders were related to the risk of suicide. The loss of sons may partly explain a subtype of late-life risk of suicide or mood disorders especially in the oldest-old. These findings can be a useful to generate other research hypothesis and for health professionals who care older persons. Detecting characteristics linked to suicide, therefore opening up the possibility of preventing tragic outcomes providing a proper treatment.

High prevalence and prescription of benzodiazepines for elderly: data from psychiatric consultation to patients from an emergency room of a general hospital.

OBJECTIVES The aim of this study is to compare the use and prescription of psychotropic drugs, with emphasis on benzodiazepines, in elderly and non-elderly patients who are assisted at the emergency room by a psychiatric consultation of a university teaching hospital. METHOD This is a cross-sectional study. We analyzed all records of psychiatric consultation in an emergency room of a general hospital from March 2009 until March 2010. Sociodemographic and clinical variables were compared between the group of elderly and non-elderly in two cutoff points (≥60 and ≥65 years), with emphasis on the use and prescription of benzodiazepines. RESULTS Five hundred seventy-five records were found with 71 elderly and 504 nonelderly for the first cutoff point and 51 elderly and 524 nonelderly in the second. Differences between groups were found in all sociodemographic variables (gender, marital status, education, current occupational status). Elderly patients treated at emergency rooms used more psychotropic drugs, particularly antidepressants and benzodiazepines, than non-elderly. About 25% of the patients received benzodiazepine treatment in the emergency setting, and there was no statistical difference between age groups. CONCLUSION There is a wide prevalence of benzodiazepine use among elderly patients in a psychiatric emergency service. Despite the recommendations for its judicious use, benzodiazepines were the most commonly used drug by psychiatrists on duty, regardless of patients age. These results call for caution in prescribing these drugs and require alternatives to the treatment of psychiatric disorders in the elderly.

Screening for depressive symptoms in older adults in the Family Health Strategy, Porto Alegre, Brazil

OBJECTIVE To analyze the prevalence of depression in older adults and associated factors. METHODS Cross-sectional study using a stratified random sample of 621 individuals aged ≥ 60 from 27 family health teams in Porto Alegre, RS, Southern Brazil, between 2010 and 2012. Community health agents measured depression using the 15-item Geriatric Depression Scale. Scores of ≥ 6 were considered as depression and between 11 and 15 as severe depression. Poisson regression was used to search for independent associations of sociodemographic and self-perceived health with both depression and its severity. RESULTS The prevalence of depression was 30.6% and was significantly higher in women (35.9% women versus 20.9% men, p < 0.001). The variables independently associated with depression were: female gender (PR = 1.4, 95%CI 1.1;1.8); low education, especially illiteracy (PR = 1.8, 95%CI 1.2;2 6); regular self-rated health (OR = 2.2, 95%CI 1.6;3.0); and poor/very poor self-rated health (PR = 4.0, 95%CI 2.9;5.5). Except for education, the strength of association of these factors increases significantly in severe depression. CONCLUSIONS A high prevalence of depression was observed in the evaluations conducted by community health agents, professionals who are not highly specialized. The findings identified using the 15-item Geriatric Depression Scale in this way are similar to those in the literature, with depression more associated with low education, female gender and worse self-rated health. From a primary health care strategic point of view, the findings become still more relevant, indicating that community health agents could play an important role in identifying depression in older adults.

Tatuagem: perfil e discurso de pessoas com inscrição de marcas no corpo

BACKGROUNDS Tattooing is an atavist and diffuse phenomenon of interest to various areas of knowledge. Its practice by specific groups such as prisoners and psychiatric patients has turned it into a stigma. OBJECTIVES To investigate the discourse of tattooed individuals about the discrimination and the construction of stigmas resulting from marks in the body. METHODS 42 individuals were interviewed and the data were analyzed. RESULTS The profile of the participants was as follows: most were women; with 2 to 4 tattoos; who were about 23 years old when they got their first tattoo; with an undergraduate degree; who viewed tattooing as a trend; who did not report any important fact that made them get a tattoo; who classified the pain of getting a tattoo as tolerable, who stated that never felt discriminated and never felt the need to hide the tattoos; who find that tattoos make them more sexually attractive; who do not view tattooing as a form of cultural resistance; who said they would not have done it if they believed it caused them professional problems; who stated that they were not drunk when they got the tattoos; who said they were not habitual drugs users, who believed that tattooing is a form of expression and aesthetic sense. CONCLUSION A difference between the discourse of tattooed individuals and their acts was observed in relation to the social context. In addition, there has been an important shift in the meaning of the practice to tattooed individuals.

Suicídio de internos em um hospital de custódia e tratamento

OBJECTIVE: To describe the profile of suicides inmates at a Forensic Psychiatric Institute in Porto Alegre from two decades. METHOD: It was a retrospective study of the inmates records with a history of death by suicide. The data were analyzed through descriptive statistics. RESULTS: There was a total of 20 cases of suicide, 70% were involuntary commitment, 70% were primary defendants, 80% of crimes against persons, the majority (45%) of suicides were committed in the daybreak period and 40% of the cases occurred in inmates that were from 1 to 9 years in the institution. They also had the following characteristics: 90% were male, 55% were between 20 and 39 years old, 70% single, 60% childless man, 85% of the subjects were originally from small towns, 25% had no profession, 84.2% had primary schooling level. The diagnostic in 55% of the cases was schizophrenia. In 75% of cases the death occurred by hanging. CONCLUSION: The data point to the profile of a single and childless man, originally from small towns, with low professional qualification and schooling. Psychosocial factors were severe mental disorder and drug or alcohol use, low social and family support, previous suicide attempts, high impulsivity and aggression.

Sleep and aging

OBJETIVO: descrever aspectos atualizados sobre as alteracoes e os disturbios do sono no processo de envelhecimento normal e usual. METODOS: procedeu-se a revisao da arquitetura do sono e ritmo circadiano de sono e vigilia para estabelecer o padrao de normalidade e as alteracoes fisiologicas no processo de envelhecimento, descrevendo-se os disturbios de sono mais prevalentes no idoso, sua avaliacao diagnostica e o manejo nao-farmacologico. O texto foi elaborado a partir da consulta as publicacoes cientificas indexadas no Medline, em outras de acesso on line e em livros textos das areas de geriatria, psiquiatria geriatrica e medicina do sono. RESULTADOS E CONCLUSAO: a maioria dos idosos tem queixas relacionadas ao sono decorrentes de mudancas fisiologicas especificas do processo de envelhecimento ou de doencas que podem causar disturbios secundarios de sono. A linha divisoria entre a normalidade e o disturbio pode ser estabelecida por meio de criteriosa avaliacao diagnostica, a qual necessariamente precede e orienta a conduta terapeutica. A maioria dos disturbios de sono sao clinicamente importantes e trataveis com medidas nao-farmacologicas, que incluem a orientacao sobre rotinas e rituais de sono, atividades de vida diaria e condicoes ambientais.AIM: to describe the up-to-date aspects on sleep changes and disturbances in the normal and usual aging process. METHODS: the sleep architecture and the sleep and vigil circadian rhythm were reviewed in order to establish the normalcy pattern and physiological changes in the aging process, describing the most prevalent sleep disturbances of the elderly, their diagnostic evaluation and non-pharmacological management. The text was drawn up based on consulting scientific publications indexed in Medline, in other on-line access publications and in textbooks in the fields of geriatrics, geriatric psychiatry and sleep therapy. RESULTS AND CONCLUSION: Most of the elderly have sleep-related complaints resulting from specific physiological changes that are specific to the aging process or to diseases that may cause secondary sleep disturbances. The borderline between normalcy and disturbance may be established by means of a judicious diagnostic evaluation that necessarily precedes and guides the therapeutic management. Most sleep disturbances are clinically significant and can be treated with non-pharmacological measures, which include guidance concerning sleep routines and rituals, everyday life activities and environmental conditions.

Prevalence and Patterns of Alcohol Misuse in a Community-Dwelling Elderly Sample in Brazil

Objective: The aim of this study was to estimate prevalence and patterns of lifetime alcohol misuse. Method: This was a cross-sectional study of a representative sample of 1,078 individuals aged 60 or more. Structured interview included sociodemographic, lifestyle, health data, and the five alcohol misuse screening questions of the Self-Reporting Questionnaire. Results: Prevalence of misuse was 6.5%. Men, aged 60 to 69, low educational level, separated/divorced, and tobacco smoking were independently associated with lifetime alcohol misuse. Odds ratios show increasing association with levels of alcohol misuse groups in males, low-educated, and tobacco users. Persons aged 60 to 69, 4 to 7 education years, and non-White ethnicity were significantly associated with the major alcohol misuse score. Discussion: Younger elderly were more exposed to alcohol than previous cohorts. Thus, problems with alcohol in old age will possibly increase as they grow older. The results of this study call attention to a field of lacking evidence in alcohol-related problems of older persons.

Aspectos do funcionamento de uma unidade de internação psiquiátrica de um hospital geral

The aim of this study is describe the general hospital psychiatric unit functioning regarding their empirical and practical aspects. Getting together to care many inpatients with several mental disorders can be a hard task. The pharmacology is empirical and palliative despite great efforts and development neuroscientific in last years. Try to discuss the conducts and management of the care with this inpatients can brig the light to the know how to proceed with them, mainly for who is beginning the psychiatric practice like students and residents.

Patterns of chronic benzodiazepine use in the elderly

Background In several countries, prevalence studies demonstrate that chronic use of BZD in the elderly population is very high. This scenario has reached pandemic proportions for decades and is an important public health problem. Objectives To examine the independent association between chronic benzodiazepine use in depression, anxiety and bipolar disorder, as well as other clinical and sociodemographic factors. Methods This cross-sectional study was developed from a population-based survey and conducted from March, 2011 to December, 2012 using a random sample of 550 elderly people who were enrolled in the Family Health Strategy in Porto Alegre, Brazil. Data was collected from identifying epidemiological and health data (sociodemographic, self-perception health, self-reported diseases, smoking, alcohol and pharmacotherapeutic evaluation) and from the diagnoses of mood and anxiety disorders. Results Elderly patients diagnosed with depression, anxiety, concomitant depression/anxiety and bipolar disorders, and those who were using antidepressants have a higher risk of benzodiazepine use. Individuals who self-reported drinking alcohol had a lower risk of benzodiazepine use. Discussion Benzodiazepines are often used by the elderly for long periods, which has a direct impact on the treatment of mood and anxiety disorders and on vulnerable groups such as the elderly, who may be unnecessarily taking these drugs.