Celso Garcia

Transtornos do humor em enfermaria de clínica médica e validação de escala de medida (HAD) de ansiedade e depressão

The revised Clinical Interview Schedule (CIS-R) and the Hospital Anxiety and Depression (HAD) Scale were used to estimate the prevalence of mood disorders among 78 consecutive admissions to a general medical ward in a university general hospital in Brazil (43 males and 35 females; mean age = 43.2yr). Interviewers also completed a 5-point symptom severity scales for anxiety and depression. The definition of cases of anxiety [and depression] was based on two criteria: a. score > or = 2 on the CIS-R section of anxiety [> or = 4 on the CIS-R sections of depression and depressive ideas]; and b. score > or = 2 on the clinical severity scale for anxiety [score > or = 2 on the clinical severity scale for depression]. A 39% prevalence rate of affective disorders was found. Sixteen (20.5%) patients met criteria for anxiety, most of the disorders being of mild severity. Twenty-sic patients (33%) were depressed, 7 of them in a moderate degree. The HAD was easily understood by the patients. Anxiety and depression subscales had internal consistency of 0.68 and 0.77, respectively. At a cut-off point of 8/9 sensibility and specificity were 93.7% and 72.6% for anxiety, and 84.6% and 90.3% for depression. HAD items correlated positively with the respective subscales. To a lesser degree, they also correlated with the alternative subscale. Our findings confirm the high prevalence of mood disorders among medical in-patients. In clinical practice, the HAD may have a useful role in detecting those patients requiring further psychological care.

Anorexia nervosa and Wernicke-Korsakoff syndrome: a case report

IntroductionWernickes encephalopathy is an acute, potentially fatal, neuropsychiatric syndrome resulting from thiamine deficiency. The disorder is still greatly under-diagnosed, and failure to promptly identify and adequately treat the condition can lead to death or to the chronic form of the encephalopathy - Korsakoffs syndrome. Wernickes encephalopathy has traditionally been associated with alcoholism but, in recent years, there has been an increase in the number of clinical settings in which the disorder is observed.Case presentationWe report the case of a 45-year-old Caucasian woman who arrived at the emergency room presenting signs of marked malnutrition and mental confusion, ataxic gait and ophthalmoplegia. Main laboratory test findings included low serum magnesium and megaloblastic anemia. Brain magnetic resonance imaging revealed increased T2 signal in the supratentorial paraventricular region, the medial regions of the thalamus and the central and periaqueductal midbrain. The diagnosis of Wernickes encephalopathy was made at once and immediate reposition of thiamine and magnesium was started. The patient had a long history of recurrent thoughts of being overweight, severe self-imposed diet restrictions and self-induced vomiting. She had also been drinking gin on a daily basis for the last eight years. One day after admittance the acute global confusional state resolved, but she presented severe memory deficits and confabulation. After six months of outpatient follow-up, memory deficits remained unaltered.ConclusionIn this case, self-imposed long-lasting nutritional deprivation is thought to be the main cause of thiamine deficiency and subsequent encephalopathy, but adjunct factors, such as magnesium depletion and chronic alcohol misuse, might have played an important role, especially in the development of Korsakoffs syndrome. The co-morbidity between eating disorders and substance abuse disorders has emerged as a significant health issue for women, and the subgroup of patients with anorexia nervosa who also misuse alcohol is probably at a particular risk of developing Wernicke-Korsakoff syndrome. The present case report highlights this relevant issue.

Functional evaluation indicates physical losses after hematopoietic stem cell transplantation.

Objective To perform a function evaluation of patients before and after hematopoietic stem cell transplantation. Methods From November 2008 to November 2010, 29 female (58%) and 21 male patients (42%) with median age of 48 years (range: 24-67) were enrolled in this study. Data collection was performed before and after autologous or allogeneic hematopoietic stem cell transplantation. Evaluation instruments included the 2-minute walking test to evaluate gait performance with assessment of the oxygen saturation, heart rate and Borg Scale before and after the test; grip strength for strength evaluation, Schober Test for spine mobility testing and maximum and adapted activity scores of the Human Activity Profile questionnaire to test functionality in daily activities. Results Fifty patients were evaluated at baseline; six did not undergo hematopoietic stem cell transplantation (three died, one refused and two were excluded). Thus 44/50 (88% - 21 allogeneic and 23 autologous) transplantations were performed. Only 33 of the 44 patients (75%) performed evaluations after transplantation (nine died and two were excluded). Of the patients who performed both evaluations, significantly lower values were found in the evaluation after transplantation for the 2-minute walking test (p-value = 0.004), grip strength of both right and left hands (p-value = 0.004 and p-value < 0.0001, respectively), the Schober Test, and maximum and adapted activity scores (p-value < 0.0001). The heart rate was higher (p-value = 0.01) before the 2-minute walking test and oxygen saturation was higher (p-value = 0.02) after. Conclusion Statistical differences indicate functional impairment after transplantation showing physical losses in this population.

Consultoria psiquiátrica em hospital geral: inviável ou promissora?

Objetivo: Avaliar alguns fatores que influenciam a pratica de interconsulta (IC). Metodos: Todos os 64 psiquiatras formados nos programas de residencia medica da PUC/RS (1977-1995) e 52 formados na Unicamp (1986-1995) foram selecionados para participar de uma entrevista por telefone sobre os seguintes itens: dados sociodemograficos, principais atividades profissionais, caracteristicas do trabalho em IC (tipo de servico, carga horaria, caracteristicas do atendimento, qualificacao profissional, motivacoes e dificuldades). Resultados: Obtiveram-se 106 (91%) entrevistas, sendo 51% dos entrevistados de sexo masculino. Um terco teve experiencia com IC apenas durante a residencia, 37% trabalham atualmente nessa area e 30% ja trabalharam em IC apos a residencia, mas haviam deixado de faze-lo. Dentre os que trabalham atualmente em IC, ha predominio do sexo masculino (qui-quadrado=6,65; p=0,03), tanto na populacao formada na PUC/RS (65%), quanto na Unicamp (63%). Apenas 6% apontam falta de treinamento adequado entre as razoes que pesaram na desistencia de trabalhar em IC. As principais dificuldades referiram-se a escassez e a imprevisibilidade do tempo despendido, a baixa remuneracao e a pouca valorizacao de parte dos colegas medicos. Conclusoes: Consideravel proporcao dos psiquiatras entrevistados continua trabalhando em IC (37%). Apesar de considerarem adequado o treinamento recebido durante a residencia, apontaram as principais dificuldades encontradas nessa tarefa: tempo, dinheiro e valorizacao do trabalho realizado.