Everton Botelho Sougey

Postpartum obsessive-compulsive disorder: prevalence and clinical characteristics

OBJECTIVE The principal aims of this study were to examine the prevalence rate, clinical characteristics, and related factors of postpartum obsessive-compulsive disorder (OCD). METHOD The subjects were a nonclinical sample of 400 postpartum women. They were interviewed from the 2nd up to the 26th week after birth. The Mini International Neuropsychiatric Interview was used for diagnosis of OCD, the Yale-Brown Obsessive-Compulsive Symptom Checklist was used to determine the types of obsessions and compulsions, and the Structured Clinical Interview for DSM-IV Axis I Disorders was used to diagnose comorbid depressive episode. RESULTS Thirty-six (9%) of the sample met the diagnostic criteria for OCD according to the Mini International Neuropsychiatric Interview, and 9 (2.3%) reported postpartum onset OCD. Obsessive-compulsive disorder was more frequent in mothers with personal history of previous psychiatric disorder, somatic disease, or obstetric complication in pregnancy/birth, and who were multiparous. The most common obsessions were aggressive, contamination and miscellaneous, and compulsion for washing/cleaning and checking, and 38.9% have a comorbid depressive episode. CONCLUSION Women have increased risk of OCD or obsessive-compulsive symptoms in the postpartum period. For this reason, all women, particularly women with previous psychiatric history, somatic disease, or with complications in pregnancy or at the birth should be carefully screened for OCD in the postpartum period.

Revisão das diretrizes da Associação Médica Brasileira para o tratamento da depressão (Versão integral)

OBJECTIVE Depression is a frequent and chronic condition with high levels of functional disability. Brazilian Medical Association Guidelines project proposed guidelines for diagnosis and treatment of the most common medical disorders. The objective of this paper is to present the original document that originated the abbreviated version available at the electronic address of Brazilian Medical Association. METHODS This paper was based on guidelines developed in other countries and systematic reviews, randomized clinical trials and when absent, observational studies and recommendations from experts. Brazilian Medical Association proposed this methodology for the whole project. RESULTS The following aspects are presented: prevalence, demographics, disability, diagnostics and sub-diagnosis, efficacy of pharmacological and psychotherapeutic treatment, costs and side-effects of different classes of available drugs in Brazil. Planning of different phases of treatment is22 also discussed. CONCLUSIONS Guidelines are a good tool helping clinical decisions and are a reference for an attitude based on levels of evidence.OBJECTIVE Depression is a frequent, recurrent and chronic condition with high levels of functional disability. The Brazilian Medical Association Guidelines project proposed guidelines for diagnosis and treatment of the most common medical disorders. The objective of this paper is to present a review of the Guidelines Published in 2003 incorporating new evidence and recommendations. METHOD This review was based on guidelines developed in other countries and systematic reviews, randomized clinical trials and when absent, observational studies and recommendations from experts. The Brazilian Medical Association proposed this methodology for the whole project. The review was developed from new international guidelines published since 2003. RESULTS The following aspects are presented: prevalence, demographics, disability, diagnostics and sub-diagnosis, efficacy of pharmacological and psychotherapeutic treatment, costs and side-effects of different classes of available drugs in Brazil. Strategies for different phases of treatment are also discussed. CONCLUSION The Guidelines are an important tool for clinical decisions and a reference for orientation based on the available evidence in the literature.

Analysis of IL-1α, IL-1β, and IL-RA polymorphisms in dysthymia

Investigators of independent studies reported alterations in cytokine serum levels in patients with different mood disorders. Several polymorphisms associated with neuropsychiatric disorders such as schizophrenia and Alzheimer’s disease have been reported at the interleukin-1 (IL-1) panel. Here we report the results of three specific polymorphisms at the IL-1α, IL-1β, and IL-1RA genes, which were analyzed in 128 Brazilian subjects: 59 dysthymic patients and 69 normal controls. We found a statistically significant difference (p=0.002) in the frequency of haplotypes with alleles 2+ (IL-1RA), T+ (IL-1α), and C+ (IL-1β) in patients as compared to controls. We also observed that haplotype IL-1RA1.2/IL-1α CT/IL-1β CC, present in 6 dysthymic patients (10%) was absent in the normal control group (p=0.012). These results suggest that these polymorphisms might confer a greater susceptibility to develop dysthymia in Brazilian patients. However, to validate these data it will be of great interest to repeat this study in larger samples and other ethnic groups.

Translation, Validation and Cultural Aspects of Postpartum Depression Screening Scale in Brazilian Portuguese:

The aim of this study was to determine the validity and reliability of a Portuguese version of the Postpartum Depression Screening Scale (PDSS). A total of 120 new mothers completed the translated version of PDSS and later were interviewed using the Structured Clinical Interview for DSM-IV Axis I Disorders, our gold standard for clinical status. The best cut-off score for the Portuguese version was 102, with a sensibility of 94%, a specificity of 95%, a positive predictive value of 75% and a negative predictive value of 99%. Reliability, measured by the alpha coefficient of internal consistency, was .95. The PDSS is considered ready for use in the screening of Brazilian new mothers for postpartum depression.

Transtornos psiquiátricos no pós-parto

OBJECTIVE: The postpartum period is marked by biological, psychological and social changes. Women are considered most susceptible to psychiatric disorders during the postpartum period. Puerperal blues, postpartum depression and postpartum psychosis have been classically associated to the postpartum. Anxiety disorders have also recently been associated to this period. METHOD: The present article reports a review of the literature on postpartum psychiatric disorders based on articles found on the PubMed and SciELO databases, published between 2000 and 2009. Relevant books, theses and other articles cited in the articles found were also included in this review. RESULTS: Puerperal dysphoria occurs in 50% to 85% of women following childbirth and is typically mild and transient in nature and requires no treatment. Postpartum depression has a prevalence rate of around 13% and can have negative repercussions on mother-infant interaction and other life events and must therefore be treated. Postpartum psychosis is rare, occurring in approximately 0.2% of puerperium cases. This condition is severe with psychotic and affective symptoms as well as risk of suicide and infanticide. Postpartum psychosis patients generally require hospital treatment. Anxiety disorders may be exacerbated or precipitated during the postpartum, particularly generalized anxiety disorder, post-traumatic stress disorder and compulsive-obsessive disorder. DISCUSSION: Although not recognized as distinct diagnostic entities under current classification systems, mental disorders during the puerperium present clinical features which warrant the attention of clinicians and researchers.OBJETIVO: O pos-parto e um periodo de alteracoes biologicas, psicologicas e sociais. Essa e considerada a epoca mais vulneravel para a ocorrencia de transtornos psiquiatricos. A disforia puerperal, a depressao pos-parto e a psicose pos-parto tem sido classicamente relacionadas ao pos-parto. Atualmente, tem sido observado que os transtornos ansiosos tambem estao associados a esse periodo. METODO: Neste artigo e feita uma revisao da bibliografia acerca de transtornos psiquiatricos no pos-parto a partir de artigos encontrados no PubMed e no SciELO entre os anos de 2000 e 2009. Livros, teses e outros artigos considerados relevantes citados no material consultado tambem foram incluidos. RESULTADOS: A disforia puerperal ocorre em 50% a 85% das mulheres, o quadro e leve e transitorio e nao requer tratamento. A depressao pos-parto tem prevalencia em torno de 13%, pode causar repercussoes negativas na interacao mae-bebe e em outros aspectos da vida da mulher e deve ser tratada. A psicose pos-parto e rara, aparecendo em cerca de 0,2% das puerperas. Tem quadro grave que envolve sintomas psicoticos e afetivos, havendo risco de suicidio e infanticidio e geralmente requerendo internacao hospitalar. Os transtornos ansiosos podem ser exacerbados ou precipitados no pos-parto, especialmente o transtorno de ansiedade generalizada, o transtorno de estresse pos-traumatico e o transtorno obsessivo-compulsivo. CONCLUSAO: Apesar de nao serem reconhecidos como entidades diagnosticas pelos sistemas classificatorios atuais, os transtornos mentais no puerperio apresentam peculiaridades clinicas que merecem atencao por parte de clinicos e pesquisadores.

Eating disorders in adolescents and their repercussions in oral health.

OBJECTIVE To examine the prevalence of oral alterations related to eating disorders and associated factors. METHOD A cross-sectional study including 650 adolescents aged from 12 to 16 was carried out through self-report questionnaires (EAT-26; BITE and self-rating hamilton depression questionnaire, SRHDQ) and dental examination. RESULTS Significant associations were observed in mucositis, cheilitis, hypertrophy of salivary glands, and dental erosions. The prevalence of adolescents at risk for eating disorders was of 33.1%, according to EAT-26 and 1.7% (high scores) and 36.5% (medium scores), in BITE, higher among 13-year-old females, with brothers, parents or responsible person who are illiterate, being the youngest child, living in a residence of at most two rooms and who showed depressive symptoms. All these factors showed significant relation to eating disorders. DISCUSSION Presence of oral alterations is associated to symptoms of eating disorders, helping precocious detection of sub clinical cases.

Transtorno de estresse pós-traumático: formulação diagnóstica e questões sobre comorbidade

OBJETIVOS: Atualizar os principais aspectos relacionados ao quadro clinico e ao diagnostico do transtorno de estresse pos-traumatico (TEPT), assim como discutir sua validade como entidade nosologica e sua comorbidade. METODOS: Descricao da sintomatologia clinica, detendo-se em seu significado fenomenologico, e revisao da literatura sobre comorbidade e validacao diagnostica. RESULTADOS: O TEPT tem sua apresentacao clinica dividida em tres grupos sintomatologicos relacionados a reexperiencia traumatica, ao comportamento de esquiva e distanciamento emocional e a hiperexcitabilidade psiquica. A estruturacao diagnostica do TEPT, especialmente a validade do constructo, vem sendo confirmada por evidencias crescentes oriundas de estudos de natureza epidemiologica e neurobiologica. A prevalencia de transtornos co-morbidos proxima a 80% desperta a atencao sobre a maneira em que e conceituado o diagnostico. Questiona-se se a imprecisao descritiva dos criterios diagnosticos, permitindo a sobreposicao de sintomas de outros transtornos, nao estaria contribuindo para uma superestimacao da prevalencia co-morbida. CONCLUSAO: O TEPT e considerado valido como diagnostico, reconhecendo e legitimando a condicao clinica, nao necessariamente temporaria, derivada essencialmente do trauma psicologico.

Action of selective serotonin reuptake inhibitor on aggressive behavior in adult rat submitted to the neonatal malnutrition

The effect of the malnutrition during suckling on the aggressiveness was investigated in adult rats treated or not with citalopram, a selective serotonin reuptake inhibitor (SSRI). The animals were divided into two groups according to the diet used: nourished group - the rats received the control diet with 23% protein during the life; and malnourished group - the rats had its mothers submitted to diet with 7.8% protein during suckling. At 120 days of age, each group was sub-divided according to the treatment: acute - consisting a single i.p. injection of saline solution or 20-mg/Kg citalopram; chronic - consisting the single injections (1 per day during 14 days) of saline or 20 mg/Kg citalopram. The acute or chronic treatment with SSRI reduces aggressive response in nourished rats, but not in malnourished ones. Thus, the malnutrition during the critical period of brain development seems to induce durable alterations in the function of the serotoninergic neurotransmission

Dissociative experience during childbirth

Objective: A dissociative experience refers to phenomena such as depersonalization, derealization, amnesia, out of body experience, altered time perception and body image. The aim of this study was to assess dissociative experience during childbirth and the possible related variables. Method: A total of 328 women, up to 72 hours postpartum, completed the peritraumatic dissociative experience questionnaire (PDEQ), the socio-demographic and obstetrical questionnaire, the pain numeric rating scale, the Trauma History Questionnaire and an SCID-I for traumatic events. Results: A total of 11.3% of the sample experienced significant dissociation. In particular, symptoms like a sensation of time changes during the event/things seemed to be happening in slow motion, not being aware of things that happened, and disorientation. A traumatic childbirth, previous trauma, obstetrical complications, forceps, prematurity, complications with the baby, dissatisfaction with the maternity care, unemployment, high score pain during labor and years of schooling were the factors considered. Conclusion: Dissociative experiences can occur during childbirth.

Internet and video game addictions: a cognitive behavioral approach

Background: While several benefits are attributed to the Internet and video games, an important proportion of the population presents symptoms related to possible new technological addictions and there has been little discussion of treatment of problematic technology use. Although demand for knowledge is growing, only a small number of treatments have been described. Objective: To conduct a systematic review of the literature, to establish Cognitive Behavioral Therapy (CBT) as a possible strategy for treating Internet and video game addictions. Method: The review was conducted in the following databases: Science Direct on Line, PubMed, PsycINFO, Cochrane Clinical Trials Library, BVS and SciELO. The keywords used were: Cognitive Behavioral Therapy; therapy; treatment; with association to the terms Internet addiction and video game addiction. Given the scarcity of studies in the field, no restrictions to the minimum period of publication were made, so that articles found until October 2013 were accounted. Results: Out of 72 articles found, 23 described CBT as a psychotherapy for Internet and video game addiction. The manuscripts showed the existence of case studies and protocols with satisfactory efficacy. Discussion: Despite the novelty of technological dependencies, CBT seems to be applicable and allows an effective treatment for this population.