Bellkiss Wilma Romano

Depression: a predictor of smoking relapse in a 6-month follow-up after hospitalization for acute coronary syndrome.

Objective The objective of the study was to investigate whether depression is a predictor of postdischarge smoking relapse among patients hospitalized for myocardial infarction (MI) or unstable angina (UA), in a smoke-free hospital. Methods Current smokers with MI or UA were interviewed while hospitalized; patients classified with major depression (MD) or no humor disorder were reinterviewed 6 months post discharge to ascertain smoking status. Potential predictors of relapse (depression; stress; anxiety; heart disease risk perception; coffee and alcohol consumption; sociodemographic, clinical, and smoking habit characteristics) were compared between those with MD (n = 268) and no humor disorder (n = 135). Results Relapsers (40.4%) were more frequently and more severely depressed, had higher anxiety and lower self-efficacy scale scores, diagnosis of UA, shorter hospitalizations, started smoking younger, made fewer attempts to quit, had a consort less often, and were more frequently at the ‘precontemplation’ stage of change. Multivariate analysis showed relapse-positive predictors to be MD [odds ratio (OR): 2.549; 95% confidence interval (CI): 1.519-4.275] (P < 0.001); ‘precontemplation’ stage of change (OR: 7.798; 95% CI: 2.442-24.898) (P < 0.001); previous coronary bypass graft surgery (OR: 4.062; 95% CI: 1.356-12.169) (P = 0.012); and previous anxiolytic use (OR: 2.365; 95% CI: 1.095-5.107) (P = 0.028). Negative predictors were diagnosis of MI (OR: 0.575; 95% CI: 0.361-0.916) (P = 0.019); duration of hospitalization (OR: 0.935; 95% CI: 0.898-0.973) (P = 0.001); smoking onset age (OR: 0.952; 95% CI: 0.910-0.994) (P = 0.028); number of attempts to quit smoking (OR: 0.808; 95% CI: 0.678-0.964) (P = 0.018); and ‘action’ stage of change (OR: 0.065; 95% CI: 0.008-0.532) (P = 0.010). Conclusion Depression, no motivation, shorter hospitalization, and severity of illness contributed to postdischarge resumption of smoking by patients with acute coronary syndrome, who underwent hospital-initiated smoking cessation.

Depressão e síndromes isquêmicas miocárdicas instáveis: diferenças entre homens e mulheres

OBJECTIVE Investigate whether social and demographic characteristics, clinical diagnosis, smoking status, alcohol consumption, and anxiety are associated with depression in patients with Acute Coronary Syndromes (ACS) stratified by gender. METHODS Three hundred forty-five consecutive patients with unstable myocardial ischemic syndrome (206 with myocardial infarction and 139 with unstable angina) were interviewed. The interviews included questions about sociodemographics, smoking status, screening for depression (Prime MD e BDI), trait and state anxiety, (IDATE), and alcohol consumption (AUDIT). RESULTS Diagnosis of depression has significantly correlated with female gender, age under 50 years, and higher average scores on trait anxiety and state anxiety. Depressed men (245) were usually younger than 50 years of age, smokers and had higher average score on trait anxiety and state anxiety than those non-depressed. The multivariate analysis highlights that age is negatively associated with depression (OR 0.9519 95% CI 0.9261 - 0.9784) and that higher scores on trait anxiety are positively associated (OR 1.0691 95% CI 1.0375 - 1.1017) with depression in the male gender. In the female sample (100), depressed women differ from non-depressed women in that they have a higher average score on trait anxiety and state anxiety. In the multivariate analysis of the female sample, a higher score on trait anxiety was independently associated with depression (OR 1.1267 95% CI 1.0632 - 1.1940). CONCLUSION It was concluded that, among hospitalized patients with ACS, women, as well as men under 50 years and who suffer from anxiety are more likely to experience depression.

Doença arterial coronariana e vivência de perdas

FUNDAMENTO: Na literatura, a depressao aparece associada a doencas cardiovasculares. A partir da experiencia clinica, observou-se a categoria vivencia de perdas associada a instalacao e ao desenvolvimento da coronariopatia. A vivencia de perdas, desencadeada por evento(s) significativo(s) apontado(s) pelo paciente, implica em processo de luto, remetendo-o aos fatores psicossociais predisponentes ao adoecer. OBJETIVO: Investigar vivencia de perdas por meio da avaliacao do estado de luto e de depressao, e verificar a relacao entre ambos, em pacientes internados com doenca arterial coronariana. METODOS: Avaliaram-se 44 pacientes internados, com os diagnosticos de infarto agudo do miocardio ou angina, de 33 a 65 anos, 50% homens e 50% mulheres. Foram utilizados dois instrumentos: entrevista semi-estruturada para investigacao de vivencia de perdas e avaliacao do estado de luto, e inventario de depressao de Beck para avaliacao de depressao. Os resultados foram relacionados pelo programa Statistical Package for Social Sciences, versao 11.0. RESULTADOS: O estado de luto pode ser identificado em 66% dos casos, com significativa relacao entre luto e depressao (p < 0,05). Observou-se ainda que 100% das pessoas com depressao grave apresentam luto. O evento significativo referido com mais frequencia foi morte de familiares (47%) e de pessoa proxima (13%), totalizando 60% dos eventos relatados por 84% dos participantes. De acordo com os resultados obtidos pelo inventario de depressao de Beck, 48% encontram-se em estado de depressao. CONCLUSAO: Este estudo sugere que a categoria vivencia de perdas deve ser utilizada como indicativo de fator psicologico predisponente as manifestacoes da doenca arterial coronariana (DAC), apontando para a relacao entre luto e depressao.

Depressive and anxiety symptoms in patients with Metabolic Syndrome

Os sintomas depressivos tem sido associados a Sindrome Metabolica. No entanto, poucos estudos avaliam simultaneamente ansiedade e depressao nessa populacao. A pesquisa teve por objetivo avaliar a intensidade de sintomas depressivos e de ansiedade em pacientes com Sindrome Metabolica, correlacionando-a com variaveis sociodemograficas. Configurou um estudo transversal e unicentrico. Utilizou-se questionario sociodemografico, Inventario de Depressao de Beck e Escala de Ansiedade de Hamilton. Participaram 103 pacientes ambulatoriais que apresentaram criterios medicos para a Sindrome Metabolica, selecionados consecutivamente. A idade media foi de 55,37 anos (±7,62), sendo 60 homens. Os sintomas de ansiedade de gravissima intensidade estiveram presentes em 51,5% pacientes (n=53), enquanto os sintomas depressivos graves estiveram presentes em 5,8% (n=6). Houve correlacao positiva e expressiva entre as escalas de depressao e de ansiedade. Concluiu-se que, nesta amostra, os sintomas ansiosos de intensidade grave foram predominantes em relacao aos sintomas depressivos, sobretudo entre as mulheres e entre individuos com baixa escolaridade.

The Wada Test: contributions to standardization of the stimulus for language and memory assessment

The Wada Test (WT) is part of the presurgical evaluation for refractory epilepsy. The WT is not standardized and the protocols differ in important ways, including stimulus type of material presented for memory testing, timing of presentations and methods of assessment. The aim of this study was to contribute to establish parameters for a WT to Brazilian population investigating the performance of 100 normal subjects, without medication. Two parallel models were used based on Montreal Procedure adapted from Gail Risses (MEG-MN,EUA) protocol. The proportions of correct responses of normal subjects submitted to two parallel WT models were investigated and the two models were compared. The results showed that the two models are similar but significant differences among the stimulus type were observed. The results suggest that the stimulus type may influence the results of the WT and should be considered when constructing models and comparing different protocols.

Coronary artery disease and experiences of losses

FUNDAMENTO: Na literatura, a depressao aparece associada a doencas cardiovasculares. A partir da experiencia clinica, observou-se a categoria vivencia de perdas associada a instalacao e ao desenvolvimento da coronariopatia. A vivencia de perdas, desencadeada por evento(s) significativo(s) apontado(s) pelo paciente, implica em processo de luto, remetendo-o aos fatores psicossociais predisponentes ao adoecer. OBJETIVO: Investigar vivencia de perdas por meio da avaliacao do estado de luto e de depressao, e verificar a relacao entre ambos, em pacientes internados com doenca arterial coronariana. METODOS: Avaliaram-se 44 pacientes internados, com os diagnosticos de infarto agudo do miocardio ou angina, de 33 a 65 anos, 50% homens e 50% mulheres. Foram utilizados dois instrumentos: entrevista semi-estruturada para investigacao de vivencia de perdas e avaliacao do estado de luto, e inventario de depressao de Beck para avaliacao de depressao. Os resultados foram relacionados pelo programa Statistical Package for Social Sciences, versao 11.0. RESULTADOS: O estado de luto pode ser identificado em 66% dos casos, com significativa relacao entre luto e depressao (p < 0,05). Observou-se ainda que 100% das pessoas com depressao grave apresentam luto. O evento significativo referido com mais frequencia foi morte de familiares (47%) e de pessoa proxima (13%), totalizando 60% dos eventos relatados por 84% dos participantes. De acordo com os resultados obtidos pelo inventario de depressao de Beck, 48% encontram-se em estado de depressao. CONCLUSAO: Este estudo sugere que a categoria vivencia de perdas deve ser utilizada como indicativo de fator psicologico predisponente as manifestacoes da doenca arterial coronariana (DAC), apontando para a relacao entre luto e depressao.

Perception of depressive symptoms in patients after myocardial infarction: Qualitative study

Background: The association between depressive symptoms and adverse outcomes in patients with coronary artery disease (CAD) is well recognized. However, few studies address the patients perception of his physical and mental condition after a myocardial infarction (MI). The present study was designed to explore the subjective aspects of the psychological conditions in post-MI patients. Method and Results: A subject population of 8 male patients (age 59±5), selected by saturation sampling, with an average of 6 months post-MI, were submitted to an individual semi-structured interview and afterwards participated in 12 psychodynamic group sessions. Conclusion: There was a predominant non-acceptance of MI due to emotional barriers and this attitude has the potential to influence negatively the adherence to a comprehensive cardiovascular treatment, including pharmacological intervention for depression

Psychological criteria for contraindication in lung transplant candidates: a five-year study.

Lung transplantation presents a wide range of challenges for multidisciplinary teams that manage the care of the recipients. Transplant teams should perform a thorough evaluation of transplant candidates, in order to ensure the best possible post-transplant outcomes. That is especially true for the psychologist, because psychological issues can arise at any point during the perioperative period. The objective of our study was to evaluate the psychological causes of contraindication to waiting list inclusion in a referral program for lung transplantation. We retrospectively analyzed data on psychological issues presented by lung transplant candidates, in order to understand these matters in our population and to reflect upon ways to improve the selection process.

Distance Psychotherapy--New Reality.

High technology progresses fast in the medical area. The most recent advance is the “big data” study, in which multiple technologies are applied to populations in order to incorporate genetic data, biological markers and imaging, to assess risks and predict the occurrence of clinical phenomena. That is a global, multidisciplinary and multinational view, which supports and helps the implementation of preventive actions. Psychology practice in Brazil, however, still resists to this modernity. Face-to-face psychotherapy is the only modality of treatment accepted by the Brazilian Federal Council of Psychology. However, distance counseling, via Internet or mobile phone, has been increasingly used in the USA, Europe and Oceania. Epstein et al.1 have reported the increasing use of “e-therapy”, as well as the exponential growth of related publications. In New Zealand, Gibson et al.2 have reported the experience of adolescents with mobile phone therapy. Eight aspects were identified by adolescents as advantageous: privacy, autonomy, control, anonymity, easy access, personalization, individualization of language, and connection. The importance of these new methodologies relates to the prevalence and incidence of emotional problems worldwide. For example, depression will be the most common non-fatal disease of the 21st century3, and an important cause of work disability and loss of quality of life, in addition to being the third cause of suicide among North-American young adults. An extensive review published in the Journal of the American College of Cardiology by Rozansky4 in 2014 showed that a number of factors, such as sleep disorders, anxiety, several forms of stress at home and in the workplace, lack of purpose in life, anger and inability to face challenges, are significantly associated with cardiovascular diseases, as well as with cardiac and all-cause mortality. Those associations depend on unhealthy life habits, such as sedentary lifestyle and smoking, and activation of the sympathetic nervous system, which trigger pathophysiological mechanisms that cause cardiovascular diseases5. Thus, there is a biologically plausible mechanistic connection of emotional and behavioral problems with organic cardiovascular disease. If, on the one hand, the understanding of the pathophysiological mechanisms belongs to the cellular and molecular biology domains, on the other, when attempting to change behaviors, physicians need the professional help of psychologists. In addition, prevention is precisely one of the pillars in the eradication of chronic non-communicable diseases, such as atherosclerosis, diabetes and hypertension, which are the major causes of mortality causes in the modern world. The fundamental requirements in the preventive strategy are changes in lifestyle, such as smoking cessation, exercise practice and the adoption of healthy diets. This is the point where the two sciences meet. Moreover, physicians often fail to recognize emotional problems, both the primary ones and those associated with organic diseases. Several psychological treatments are misused, and the number of cases treated is insufficient, barely reaching 50%3. On the other hand, the economic burden of depression and dementia is astronomical6,7. In the USA, the cost of depression, mainly related to absenteeism and poor work performance, has reached U

Enfermedad arterial coronaria y vivencia de pérdidas

53 billion in one year. Regarding dementia, Hurd et al.7 have estimated individual costs between U