Ana Flávia Barros da Silva Lima

Association between psychiatric symptoms and severity of alcohol dependence in a sample of brazilian men.

The objective of this study was to verify the association between psychiatric symptoms and severity of alcohol dependence in male patients who sought treatment in two Brazilian treatment sites. A cross-sectional study was designed with 36 cases stratified into two groups according to the severity of alcohol dependence ascertained by the Short Form Alcohol Dependence Data scale; participants also answered the Mini-Mental State Examination, the Mini International Neuropsychiatric Interview, and the Symptom Check List 90. The mean age of the sample was 46 years, and 63.9% fulfilled criteria for severe alcohol dependence. Obsessive-compulsive, depressive, and paranoid symptoms were the most common clinical findings in the sample. Patients with severe dependence showed higher scores of psychiatric symptoms compared with patients with mild/moderate dependence across all analyses (p < .05). These data suggest an association between severity of alcohol dependence and psychiatric symptoms, pointing at the relevance of early detection of this clinical situation.

Quality of life, diagnosis, and treatment of patients with major depression: a prospective cohort study in primary care

OBJECTIVE To describe the demographic and clinical characteristics, adequacy of antidepressant treatment, and changes in quality of life of patients with major depression receiving follow-up care from primary care centers. METHOD A cohort study was performed in which major depression patients were followed-up over a nine-month period. Several evaluation instruments were used, including the World Health Organization Quality of Life and the Quality of Life-Depression, Centers for Epidemiologic Studies-Depression questionnaires. RESULTS The sample comprised 179 individuals, mostly female (73%), with a mean age of 38 years and mean education of 9 years. At the end of the follow-up period, 42% of the individuals still presented with major depression, 25% had complete symptom remission, and only 9% were properly treated with antidepressants. In relation to quality of life, there were significant differences especially between baseline and after nine months in almost all measures. CONCLUSION This study demonstrated that depressive symptoms are poorly recognized and that treatment is often inadequate for patients followed-up in primary care units in the south of Brazil. Most of the patients continued to have symptoms of depression over the nine-month period which were associated with impaired quality of life.

Qualidade de vida e depressão: uma revisão da literatura

Depressive symptoms are highly prevalent, mainly in primary health care services, causing serious impairments in those subjects that are not treated. The objective of this study was to review the impact of the association between depressive disorder and quality of life. Our review included articles published between 1990 and 2007 and it was based on the following keywords: quality of life, depression, depressive symptoms, primary care services, well-being, happiness, and predictors of remission. The presence of depressive symptoms affects all dimensions of the quality of life, and depending on the severity of these symptoms, it might cause equivalent or more severe impairment than other chronic diseases. The findings suggest that the presence of depressive symptoms causes a serious impact on the quality of life of individuals. Such impact is not limited to the clinical characteristics of the disorder. However, there is still a lack of theoretical models and longitudinal v31n3a02s1

Mental health economics: Insights from Brazil

Background As the responsibility and demand on health care grows and resources do not increase at the same pace, the healthcare system has been forced to reconsider the benefits and costs of their actions, to ensure a rational and effective decision-making process regarding the adoption of interventions and allocation of resources. Cost-effectiveness (CE) studies represent one of the basic tools to achieve this goal. Aims: To present the current state of Health Technology Assessment (HTA) and health economics in mental health in Brazil and its importance to the decision-making process. Methodology: Descriptive paper on HTA and health economics in Brazil. Databases from government and universities as well as some scientific databases to assess the information are presented. Results and Conclusion: Economic analysis to evaluate interventions in mental health care is a relatively recent addition to the field of health economics; in Brazil, it is also considered a topic within Epidemiology research area. There have been an increased number of studies developed in high-income countries. However, there are fewer CE studies in low- and middle-income ones. Psychiatric disorders represent a significant burden in developing countries, where resources devoted to health care are even scarcer.

Limites e alternativas para a implementação de um programa para dependentes químicos em risco para infecção pelo HIV utilizando o conceito de Rede Social

Os autores descrevem as etapas de execucao de um programa de acoes preventivas para usuarios de drogas sob risco de infeccao pelo virus da imunodeficiencia humana (HIV), utilizando como paradigma de intervencao um modelo de abordagem de redes sociais. Sao descritos os passos de instalacao do projeto dentro de um grande hospital universitario do sul do Brasil, com enfase nos metodos e tecnicas originais desenvolvidos pela equipe de atendimento. As dificuldades de implementacao do projeto sao discutidas ao longo das secoes, buscando identificar os motivos pelos quais o programa obteve exito apenas parcial. Os autores destacam alguns pontos criticos, tais como a utilizacao de uma tecnica ainda nao difundida em nosso meio, a dificuldade de reter em tratamento usuarios de drogas injetaveis, a falta de estrutura para atendimentos imediatos, e as dificuldades em motivar equipes e pacientes para o tratamento. Ao final do texto, sao feitas sugestoes com o objetivo de facilitar o desenvolvimento de novos projetos que busquem utilizar o mesmo modelo conceitual.The authors describe the development of a preventive program focused on intravenous drug users at risk of HIV infection using the Social Network Approach as the intervention model. The authors describe the project’s steps in a large university hospital in southern Brazil emphasizing the unique methods and techniques developed by the treatment staff. Problems encountered during the project development are discussed aimed at identifying the reasons why the program only achieved partial success. The authors identify critical issues such as the use of a new technique not previously tried in Brazil difficulties in maintaining IV drug users in treatment lack of infrastructure for walk-in treatment and the challenge of motivating staff and patients to continue treatment. The authors conclude by listing suggestions aimed at facilitating the development of new projects based on the same conceptual model. (authors)

Economic evaluation in the field of mental health: conceptual basis.

OBJECTIVE Technological advances in medicine have given rise to a dilemma concerning the use of new health technologies in a context of limited financial resources. In the field of psychiatry, health economic evaluation is a recent method that can assist in choosing interventions with different cost and/or effectiveness for specific populations or conditions. This article introduces clinicians to the fundamental concepts required for critical assessment of health economic evaluations. METHODS The authors conducted a review with systematic methods to assess the essential theoretical framework of health economic evaluation and mental health in Brazil through textbooks and studies indexed in the PubMed, Cochrane Central, LILACS, NHS CRD, and REBRATS databases. A total of 334 studies were found using the specified terms (MeSH - Mental Health AND Economic, Medical) and filters (Brazil AND Humans); however, only five Brazilian economic evaluations were found. RESULTS AND CONCLUSIONS Economic evaluation studies are growing exponentially in the medical literature. Publications focusing on health economics as applied to psychiatry are increasingly common, but Brazilian data are still very incipient. In a country where financial resources are so scarce, economic analyses are necessary to ensure better use of public resources and wider population access to effective health technologies.

Aspectos da prática da eletroconvulsoterapia: uma revisão sistemática

A eletroconvulsoterapia (ECT) e um tratamento eficaz para uma serie de transtornos psiquiatricos. Observa-se, contudo, que a sua pratica ainda conta com uma serie de questoes nao bem compreendidas. Isso explica, em parte, as diferencas na sua aplicacao em diferentes servicos e a falta de protocolos claros para a sua execucao. O presente trabalho e oriundo de uma revisao sistematica da literatura sobre a ECT (MEDLINEO 1993-2003). Ele visa a buscar respostas para as seguintes questoes: ha diferenca, em termos de eficacia, entre o posicionamento uni ou bilateral dos eletrodos? Com que dosagem eletrica deve-se iniciar uma serie de ECT? Qual a real importância do limiar convulsivo? O que e uma crise convulsiva adequada e como proceder na ausencia da mesma?

Electronic Version of the EQ-5D Quality-of-Life Questionnaire: Adaptation to a Brazilian Population Sample

OBJECTIVES To assess the measurement equivalence of the original paper version of an adapted tablet version of the EuroQol five-dimensional questionnaire (EQ-5D). METHODS A randomly selected sample of 509 individuals aged 18 to 64 years from the general population responded to the EQ-5D at two time points separated by a minimum interval of 24 hours and were allocated to one of the following groups: test-retest group (tablet-tablet) or crossover group (paper-tablet and tablet-paper). Agreement between methods was determined using the intraclass correlation coefficient (ICC) and the κ coefficient. RESULTS In the crossover group, the following ICC values were obtained: 0.76 (confidence interval [CI] 0.58-0.89) for EQ-5D scores and 0.77 (CI 0.68-0.84) for visual analogue scale in subjects responding first to the tablet version; 0.83 (CI 0.75-0.89) for EQ-5D scores and 0.75 (CI 0.67-0.85) for visual analogue scale in subjects responding first to the paper version. In the test-retest group, the ICC was 0.85 (CI 0.73-0.91) for EQ-5D scores and 0.79 (CI 0.66-0.87) for visual analogue scale. The κ values were higher than 0.69 in this group. The internal consistencies of the paper and tablet methods were similar. CONCLUSIONS The paper and tablet versions of the EQ-5D are equivalent. Test-retest and crossover agreement was high and the acceptability of the methods was similar among individuals.

Effectiveness evaluation of mood disorder treatment algorithms in Brazilian public healthcare patients

Objective: To assess the effectiveness of three mood disorder treatment algorithms in a sample of patients seeking care in the Brazilian public healthcare system. Methods: A randomized pragmatic trial was conducted with an algorithm developed for treating episodes of major depressive disorder (MDD), bipolar depressive episodes and mixed episodes of bipolar disorder (BD). Results: The sample consisted of 259 subjects diagnosed with BD or MDD (DSM-IV-TR). After the onset of symptoms, the first treatment occurred ∼6 years and the use of mood stabilizers began ∼12 years. All proposed algorithms were effective, with response rates around 80%. The majority of the subjects took 20 weeks to obtain a therapeutic response. Conclusions: The algorithms were effective with the medications available through the Brazilian Unified Health System. Because therapeutic response was achieved in most subjects by 20 weeks, a follow-up period longer than 12 weeks may be required to confirm adequate response to treatment. Remission of symptoms is still the main desired outcome. Subjects who achieved remission recovered more rapidly and remained more stable over time. Clinical trial registration: NCT02901249, NCT02870283, NCT02918097

Assessment of the psychometric properties of the 17- and 6-item Hamilton Depression Rating Scales in major depressive disorder, bipolar depression and bipolar depression with mixed features

Assessing therapeutic response in depression requires scales that adequately measure the core symptoms of depressive symptomatology. The main goal of this study was to assess the psychometric properties of the 17-item Hamilton Depression Rating Scale (HAM-D17) and the 6-item Hamilton Depression Rating Scale (HAM-D6) in patients with Major Depressive Disorder (MDD), bipolar depression and bipolar depression with mixed features. We conducted a reanalysis of a pragmatic clinical trial in an outpatient clinic for mood disorders that included eight weeks of follow-up. A Mokken analysis was performed to evaluate the unidimensionality of the HAM-D17 and HAM-D6, and the Spearman correlation was used to assess concurrent validity between the HAM-D17, the HAM-D6 and quality of life scale (SF-36 and WHOQOL-BREF) scores. A total of 237 patients with a mean age of 40.2 years (±11.7) were included. According to the DSM-IV criteria, 58 (24.5%) were diagnosed with MDD and 73 (30.8%) were diagnosed with bipolar depression. Bipolar depression with mixed features was diagnosed in 106 (44.7%) patients according to the DSM-IV and supplemented by the Cincinnati criteria. Only the HAM-D6 scale proved to be unidimensional, showing strong homogeneity for evaluating MDD, moderate homogeneity for bipolar depression and weak homogeneity for bipolar depression with mixed features. Both the HAM-D17 and the HAM-D6 had inverse, significant correlations at baseline with SF-36 and WHOQOL-BREF scores. This is the first study to include bipolar depression patients with mixed features in an assessment of HAM-D6 unidimensionality.